Increasing disparities between resource inputs and outcomes, as measured by certain health deliverables, in biomedical research

Abstract

Society makes substantial investments in biomedical research, searching for ways to better human health. The product of this research is principally information published in scientific journals. Continued investment in science relies on society’s confidence in the accuracy, honesty, and utility of research results. A recent focus on productivity has dominated the competitive evaluation of scientists, creating incentives to maximize publication numbers, citation counts, and publications in high-impact journals. Some studies have also suggested a decreasing quality in the published literature. The efficiency of society’s investments in biomedical research, in terms of improved health outcomes, has not been studied. We show that biomedical research outcomes over the last five decades, as estimated by both life expectancy and New Molecular Entities approved by the Food and Drug Administration, have remained relatively constant despite rising resource inputs and scientific knowledge. Research investments by the National Institutes of Health over this time correlate with publication and author numbers but not with the numerical development of novel therapeutics. We consider several possibilities for the growing input-outcome disparity including the prior elimination of easier research questions, increasing specialization, overreliance on reductionism, a disproportionate emphasis on scientific outputs, and other negative pressures on the scientific enterprise. Monitoring the efficiency of research investments in producing positive societal outcomes may be a useful mechanism for weighing the efficacy of reforms to the scientific enterprise. Understanding the causes of the increasing input-outcome disparity in biomedical research may improve society’s confidence in science and provide support for growing future research investments.

Placebo and nocebo phenomena from the perspective of evidence based and person centered medicine

“…Non-adherence to drug treatment and non-cooperation of patients may be related to nomothetic impersonal and technical rationality followed by nocebo response [27]. Some studies have also stressed a decreasing quality of published literature due to an increasing competition for grants and jobs, the current mania for publishing papers and a disproportionate emphasis on quantity over quality in scientifi c outputs, huge administration, and overreliance on reductionism [10], linear, mechanistic and formistic information processing. EBM's aims to improve health-care eff ectiveness and effi ciency have been thwarted by bias in the choice of hypotheses tested, manipulation of study design and selective publication, particularly in industryfunded trials [18].…”

“…stroke and myocardial infarction aft ercare. However, in the last years there has been an increasing number of warning reports "that in modern research, misrepresented, false and un-useful fi ndings may be the majority or even the vast majority of published research claims" [ 5,6,7,8,9,10,11]. Some authors claim that EBM is failing due to biased trials and selective publication [12].…”

Bibliometric Characteristics and Citation Impact of Funded Research: A Case Study of Tribology

“…[1] During the 20 th century, science was increasingly funded by governments and corporations vying for military and economic advantage. [2] Many national funding decisions are supported by citation and publication metrics, e.g. the national Norwegian model for research performance, the upcoming UK Research Excellence Framework and the Chinese academic evaluation system.…”

Quality Assurance in Biobanking for Pre-Clinical Research

“…Recent publications have focused on the increasing disparities between resource inputs and outcomes in biomedical research [12]. It was estimated that more than USD 28 billion are spent each year in the USA alone on irreproducible pre-clinical research, which is a fundamental loss for upstream processes regarding the translation towards clinical applications [13].…”