Editor`s Opinion: Investments in Healthcare: Observations of a Changing Landscape in Manuscript Submissions

  Reading a typical issue of Ostomy Wound Management today, it is hard to believe that, for many years, we worked hard at publishing an annual “International Issue” to highlight the work of our colleagues across the globe. During the past several years, the number of publications from non-US-based clinicians and researchers in this and other wound care journals has increased substantially. Of course, the process of searching the literature and submitting manuscripts is also much simpler than it used to be. Trips to a library with an ample supply of medical and nursing journals are no longer required, nor are visits to the local post office to send all the required disclosures, three hard copies of the manuscript, and three sets of original, camera-ready (!) figures.

  When we first started noticing an increase in the submission rate from non-US-based clinicians, we considered a potential worldwide increase in wound-related research or the changes in process that have occurred. We thought that maybe more manuscripts are submitted because potential geographical limitations to research and publishing no longer exist. At the same time, however, we have seen a reduction in the number of manuscripts from US-based clinicians, even though the entire process also has been simplified for them.

  So what is going on? Is it possible that current trends in the area of wound, ostomy, and skin care research are a reflection of changes in university-based research in the US? According to a recent report, in 2008, the US ranked 22 out of 30 countries in government-funded university research and 21 in business-funded university research. From 2000 to 2008, the growth of government-funded university research was significantly higher in countries such as China, Korea, and the United Kingdom than in the US.¹ The author of this report observes that “while our research universities, public and private, are still a key strength, their future is uncertain given the large cuts in state higher education budgets and slow growth in federal support for university research.”

  These observations about US-based research are similar to those published a few years earlier. After studying trends in biomedical research from 2003 to 2008 and comparing these findings to previous study results, Ray Dorsey, MD, observed, “The era of rapid expansion in biomedical research funding that began in the 1990s has ended.”² As in the past, industry — pharmaceutical, biotechnology, and medical device firms — continues to supply the largest proportion of total research spending (58%), followed by the federal government at 33%. However, between 1994 and 2003, the compound annual growth rate of research expenditures by industry (adjusted for inflation) was 8.1%, a much higher proportion than the 5.8% growth rate between 2003 and 2007. At the same time, National Institutes of Health (NIH) contributions decreased by 8.6%, from $31.8 billion in 2003 to $29.0 billion, in 2007 (adjusted for inflation). When adjusted for inflation, total federal funding increased by $200 million (0.7%) from 2003 to 2007, compared to a nearly 100% increase from 1994 to 2003, a statistically significant difference.²

  Even though industry research growth in medical device companies outpaced that of biotechnology and pharmaceutical companies,2 and a substantial portion of wound, ostomy, and skin care research is conducted with device company funding, worldwide economic developments since the publication of this research do not bode well for the immediate future.

  In 2009, only 6 cents of every healthcare dollar spent in the US went to health-related research, an amount that has remained relatively unchanged since 2001.³ And budget cutting continues to be the norm in the US and many other industrialized nations.

  Most manuscripts are the end product of many years of work; thus, it is entirely possible that what we have observed the past several years is a reflection of reduced research funding in the US and increases in research funding elsewhere during the first decade of this century. Economic trends do not only affect direct funding. They also influence our day-to-day work environment. Doing more with less — whether resources or people — has become the norm. So, if funding is more difficult (and time-consuming) to obtain and personnel levels are less-than-optimal, where does one find the time and energy to advance science?

  To not advance is to go backwards. We cannot afford to stop because the graying of our population will not stop and nobody can afford the cost of providing less-than-optimal care. But while I worry about the state of wound and skin care science in the US, it is encouraging to know that the community of wound care clinicians and researchers is growing and expanding. We can capitalize on this strength in numbers and diversity by spreading the word that, no matter where we live, the cost of not investing in the future of healthcare is simply too great.

 This article was not subject to the Ostomy Wound Management peer-review process.

1. Atkinson RD, Stewart LA. University research funding: behind and falling. The Information Technology and Innovation Foundation. March 19, 2011. Available at: www.itif.org/publications/university-research-funding-united-states-behind-and-falling. Accessed June 8, 2011.

2. Dorsey ER, Roulet J, Thompson JP, Reminick JI, et al. Funding of US biomedical research, 2003-2008. JAMA. 2010;303(2):137–143.

3. Research!America. 2009 US investment in health research. Available at: www.researchamerica.org/uploads/healthdollar09.pdf. Accessed June 4.