publications, conference presentations, markets, and informal networks. A second channel is through the creation of prototypes for drugs and devices. Since the Bayh-Dole Act of 1980, these prototypes have tended to be developed in universities and licensed out to firms to turn them into successful products. A third channel includes funding for clinical trials and clinical research that informs clinical practice—such as the knowledge that doctors should give people an aspirin after a heart attack—along with funding of other applications-oriented work, such as contracts to fund the development of technologies and to conduct consensus conferences.

Sampat called attention to another impact of new biomedical technologies that is being discussed among health policy researchers. Most economists believe that biomedical technologies are the biggest source of long-run increases in health care costs. The clinical value from these technologies may exceed their costs, but technology-driven cost increases may be unsustainable, Sampat observed.

The Case of Cardiovascular Disease

Sampat described some of the literature on improvements in health outcomes that can be traced to research. Cutler and Kadiyala (2007) looked at improvements in cardiovascular disease mortality over the five decades beginning in 1950, when mortality fell by two-thirds. They concluded that about one-third of the advance is attributable to new high-technology treatments, one-third to new drugs, and one-third to behavioral changes such as not smoking and not eating salty or fatty foods. Using a standard evaluation of $100,000 per year of life used by health economists, they then computed the rate of return on investments in treatments. New treatments provided a 4-to-1 rate of return, while new behavioral knowledge produced a 30-to-1 rate of return. According to this paper, Sampat said, “the publicly funded R in R and D has been worth it.”

This paper makes little mention of NIH or public research except for NIH’s sponsorship of large epidemiological trials and conferences, which makes it hard to trace outcomes back to basic research. Another issue, said Sampat, is the counterfactual: What would have happened in cardiovascular disease absent any public funding in that area?

A paper by Heidenreich and McClellan (2007) focused on improvements in heart attack care. These authors go farther than Cutler and Kadiyala in relating changes in clinical practice to specific outputs of

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