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Sunday, October 30, 2016

Medical Research-Where Does the Money Come From



Medical Research Funding
Yesterday, I attended the perennial Benaroya Research Institute-Virginia Mason annual luncheon which raises money for medical research. This article reviews who funds scientific research in the United States and beyond and the main recipients of those funds.
Virginia Mason Medical Center is a 96-year-old organization, created as a teaching hospital. The Virginia Mason Research Institute was created in 1956 to conduct primary research on diabetes, eventually branching out into the pantheon of autoimmune diseases, from rheumatoid arthritis to lupus. In 2002, the research institute was renamed the Benaroya Research Institute, thanks to an endowment from a local family.  Research developments have accelerated since then and have created a unique partnership between practicing clinicians and scientists, who share findings in an annual Clinical and Translational Research Symposium. This type of partnership increases the rate of individual participation in clinical trials, which follow the scientific study to determine how well an intervention works with actual patients. At present, BRI has over 440 scientific studies and 80 of those are still accepting participants. BRI is the lead investigator for the global TrialNet study on diabetes and for the Immune Tolerance Network. In 2015, 83%, of BRI’s 65-million-dollar budget came from research grants and of that total, 72% were government grants. For the remainder, 13% of the annual budget was from direct donations and revenue from endowments.
 Healthcare Research Grant Funding
The organization which provides the most funding for medical research is the National Institutes of Health, part of the Health & Human Services Agency in the federal government of the U.S.  The NIH gave $      23,530,197,762 in research grants in 2016 and about 20% of that went to these 10 universities in the U.S. (National Institutes of Health, 2016)
Top Grant Recipients for Healthcare Research
Grant Recipient
City
State
# of awards
Total Amount
Johns Hopkins University
Baltimore
Maryland
1,276
$634,940,987
University of California San Francisco
San Francisco
California
1,196
$575,219,351
University of Michigan
Ann Harbor
Michigan
1,097
$483,326,335
University of Pennsylvania
Philadelphia
Pennsylvania
1,094
$473,635,717
University of Pittsburgh
Pittsburgh
Pennsylvania
1,040
$472,566,210
Stanford University
Stanford
California
929
$425,062,412
University of North Carolina Chapel Hill
Chapel Hill
North Carolina
861
$408,423,743
Yale University
New Haven
Connecticut
917
$406,376,306
University of Washington
Seattle
Washington
862
$402,088,254
University of California, San Diego
La Jolla
California
830
$400,413,190

There are few surprises in this list of medical research organizations, except the total absence of the Boston, Massachusetts contingent, namely Harvard. The NIH funding was spread over 2,433 entities, when you exclude some groups which received placeholder awards of one dollar, probably to qualify them for a 2017 grant. So, many of these grants are very small ($5,000). Interestingly there were 38 foreign entities which received NIH grants, for projects like HIV, Zika, and other global health epidemics. Total NIH grants awarded to other countries were $171,385,671 and less than 1% of total 2016 grant awards.
 Top Ten Foreign Recipients of NIH Grants
Grant Recipient
Country
Total Amount
Universities
Canada
$39,420,859

Private foundations & universities
South Africa
$28,244,743

Universities & some private companies
United Kingdom
$23,794,876

Universities & institutes
Germany
$12,636,729

Universities
Australia
$9,044,715

Academic research institute
Switzerland
$5,585,984

Universities
Nigeria
$5,477,084

University & research groups
Peru
$5,223,909

University
France
$4,143,730

Funds a project with U.S. hospital
Uganda
$3,931,439


Healthcare research is also funded by private foundations and corporations. The largest private foundation in the world is the Bill and Melinda Gates Foundation, based out of Seattle, Washington, which spends the majority of its grants on healthcare for developing countries. Path, is another Seattle organization which has a global presence and spent 130 million on world health care in 2007. In 2005, private healthcare spending on global health was estimated at 1.6 billion of that, 916 million was paid out in health grants. (David McCoy, 2009) According to the Gates Foundation web site, the foundation awarded 420 global health grants in 2015 and a total of 4.2 billion dollars in grants overall. (Gates Foundation.org, 2016) The top 20 foundations based on total giving and located in the United States are listed below and as you can see, most of the money goes to healthcare and is highlighted in green in proportion to the program focus. Also the pharmaceutical companies donate drugs to patients who can’t afford their ridiculous prices and book a retail gift contribution on their financial statements. Pharmaceutical companies donated 1% or less of their foundation assets whereas the Gates Foundation donated 6% of its total assets in the same year. The patient assistance programs do not include any money for scientific research. (Foundation Center.org, 2015)
Top 20 Largest Foundations in the U.S. Based on 2014 Gift Awards
   Bill and Melinda Gates Foundation-$3,439,671,694
Silicon Valley Community Foundation-$956,834,000 
The Abbvie Patient Assistance Foundation-$853,356,400
The Bristol-Myers Squibb Patient Assistance Foundation-$811,433,684
Johnson and Johnson Patient Assistance Foundation-$711,632,110 
  Merck Patient Assistance Program, Inc.-$686,800,564
Genentech Access to Care Foundation-$680,278,040 
 Pfizer Patient Assistance Foundation, Inc.-$668,050,404
  GlaxoSmithKline Patient Access Programs Foundation-$625,427,284 
 The Atlantic Philanthropies-$521,711,000
 Ford Foundation-$518,380,000
  Lilly Cares Foundation, Inc.-$503,299,479
Sanofi Foundation for North America-$485,359,572 
 Novartis Patient Assistance Foundation-$456,825,176
The Susan Thompson Buffett Foundation-$41,440,853
Foundation to Promote Open Society-$410,571,424
Walton Family Foundation, Inc.-$360,527,538 
 The William and Flora Hewlett Foundation-$353,550,000
The Robert Wood Johnson Foundation-$346,240,905 
 Foundation for the Carolinas-$341,637,974
In addition to global health foundations, there are disease specific foundations, which contribute money to scientific research and this list represents the top performers, by virtue of the proportion of their annual giving in relation to total revenues. (Philippides, 2013)
Disease Specific Foundation Scientific Grant Awards for 2011 
 Michael J. Fox Foundation-Parkinsons-82.6% of total revenue to research
Juvenile Diabetes Research Foundation-57% of total revenue to research
Myelin Repair Foundation-53.9% of total revenue to research
Alzheimer’s Drug Discovery Foundation-52% of total revenue to research 
  Parkinson’s Disease Foundation-46% of total revenue to research
How do Other Countries Compare to the U.S. For Medical Research
In attempting to compare how other countries stack up to the U.S. in terms of medical and scientific research, I reviewed the number of published scientific journal articles and frequency of citations for them. Though the U.S. still produces the lion’s share of scientific research (40%), China, Japan, and Brazil have also been increasing their research output. At the present time, the leaders in producing scientific research are listed in order of precedence: United States, United Kingdom, Germany, Canada, France, Australia, Italy, Spain, Netherlands, Switzerland, Japan, and China.
Global health is a term bandied about in the news media, but in a world with limited natural resources and burgeoning increasingly transient populations, health in one country or continent really does have an effect on those living in lands far removed from the scourge of war, famine, or tropical disease. All we have to do is look at the news clips of Calais and understand that over 1,000 unaccompanied children made the journey from North Africa or the Middle East for their dream of a better life. These poor souls were willing to squat in the rain indefinitely waiting for the United Kingdom to let them emigrate.
Scientists and healthcare researchers spend their careers, often for 30 years, performing molecular research and patiently testing hypotheses to make advancements in medicine. Since it is the fourth quarter of the year, I encourage readers to make a contribution to a healthcare research facility in 2016.

This article was written by Roberta Winter, under her trademark, healthpolicymaven and may be shared virally. Winter is the author of Unraveling U.S. Healthcare-A Personal Guide, Rowman & Littlefield, 2013.

References

David McCoy, S. C. (2009). Global health funding: how much, where it comes from and where it goes. Oxford Journals, Medicine and Health Policy and Planning. Oxford, UK: Oxford Journals . doi:doi: 10.1093/heapol/czp026
Foundation Center.org. (2015). 50 Largest Foundations by Total Giving in 2014. Retrieved October 30, 2016, from Foundation Data Foundation Center.org: http://data.foundationcenter.org/#/foundations/all/nationwide/top:giving/list/2014
Gates Foundation.org. (2016, October 29). Gates Foundation-Who We Are-Fact Sheet. Retrieved from Gates Foundation.org: http://www.gatesfoundation.org/Who-We-Are/General-Information/Foundation-Factsheet
National Institutes of Health. (2016). NIH Award by Location and Organization as of 10/16/2016. Retrieved October 29, 2016, from https://report.nih.gov/award/index.cfm?ot=&fy=2016&state=&ic=&fm=&orgid=&distr=&rfa=&om=n&pid=
Organization for Economic Development and Cooperation. (n.d.). Net Flows In Foreign Aif By Country-2014. Organization for Economic Development and Cooperation. Retrieved October 29, 2016, from http://www.oecd.org/dac/stats/statisticsonresourceflowstodevelopingcountries.htm
Philippides, A. (2013, May 23). Top 20 Grant Giving Disease Foundations. Retrieved October 30, 2016, from Genetic Engineering & Biotechnology News: http://www.genengnews.com/insight-and-intelligence/top-20-grant-giving-disease-foundations/77899817?page=2

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