graduate students into immunology.

Industrywide data on the amount of money spent on immunology-specific research are not available, so the panel chose to examine trends in industry-supported research for the entire biotechnology industry. Biotechnology industry support for research is much greater in the United States than in Europe as shown in Table 3.2-3.3 (Ernst & Young, 1998b). This financing of research and the use of many academic researchers for consultation in biotech firms and large pharmaceutical firms have provided relatively direct avenues for postdoctoral immunologists to obtain employment, to move across disciplines, and to capitalize rapidly on technology developments that are fostered primarily in biotech firms. In addition, the role of many US academic researchers in founding or participating in the founding of biotechnology firms has enhanced the linkage between academic and industrial research in immunology. In some cases (decidedly a minority), the necessity for patent protection has sometimes impeded the flow of information from research developments in biotechnology and pharmaceutical firms. The ability of biotech firms and large pharmaceutical firms to take discoveries from academic research into startup companies and then large firms and into clinical application has been an overall benefit for the development of clinical immunology in the United States. This entrepreneurial approach has also translated into an economic advantage for the United States over other countries. As shown in Figure 3.1, the United States has a net positive trade balance in biotechnology-based products that was in the low $600 million range in 1990, rose to almost $1 billion in 1994 and then decreased to about $650 million in 1996. (NSF, 1998: Appendix Table 6-6)

3.5 The Clinical Trial

There is a shortage of people in the United States trained to design and administer large-scale trials of new immunology-based therapies. In addition, the impact of managed care has narrowed the patient base available for this type of clinical research, except in large, nonprofit managed-care organizations, such as the Kaiser-Permanente organization.

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