5

SUMMARY AND CONCLUSIONS

The multiple assessment methods used in this study resulted in very similar findings, although the benchmarking process was limited by a scarcity of rigorous and unbiased data. A scientifically rigorous benchmarking process was not possible, because independent and unbiased adequate data could not be identified. The methods, despite their flaws, were the best available to us. Their results, with the panel 's judgment, support the conclusions presented below.

5.1 The United States Is The World Leader In All The Major Subfields Of Immunology But Is Only Among The World Leaders In Some Specific Sub-Subfields.

On the basis of the results of three benchmarking methods—a virtual-congress survey, citation analysis, and publication counts –the United States appears to be preeminent in immunology. Furthermore, it leads in all four of the subfields examined: cellular immunology, molecular immunology, immunogenetics, and clinical aspects of immunology. That is not a surprising result, given the size of the US enterprise, which writes some 60% of the immunology papers published each year. However, what is of greater interest, given the size of the enterprise, is that in some sub-subfields the United States is only among the world leaders: lymphocyte development and self-nonself recognition, inherited immunodeficiency, tumor immunology, and transplantation and immunosuppressive drugs.

The inherent flaws of each method make rigorous and exact assessment of US leadership impossible. However, these approaches do yield an estimation of the present standing of the United States in immunology. Because the exploration of immunology is an international endeavor, the high degree of cooperation and collaboration among US and non-US scientists should be highlighted.

Current US leadership has been documented by a number of quantitative and semiquantitative measures, but these measures do not show the breakthrough discoveries that are recognized by such awards as the Nobel Prize (half the immunology awardees were non-citizens). Nor do they reveal that a very significant fraction of the leading US scientists received some of or all their training in non-US institutions, mainly as nationals in other countries; several of these were Nobel laureates for research done outside of the United States.

5.2 Flexibility To Pursue Original And Innovative Research Ideas Has Attracted Both Domestic And International Human Capital. Federal, State, And Private Funding Have All Contributed To A Climate Ripe For This Innovative Research.

The United States has been able to attract talented foreign students to be both graduate and postgraduate investigators in immunology laboratories to a greater degree than other countries have been able to attract US students. That is in part due to the research opportunities available within the United States for these students as they seek to advance their



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INTERNATIONAL BENCHMARKING OF US IMMUNOLOGY RESEARCH 5 SUMMARY AND CONCLUSIONS The multiple assessment methods used in this study resulted in very similar findings, although the benchmarking process was limited by a scarcity of rigorous and unbiased data. A scientifically rigorous benchmarking process was not possible, because independent and unbiased adequate data could not be identified. The methods, despite their flaws, were the best available to us. Their results, with the panel 's judgment, support the conclusions presented below. 5.1 The United States Is The World Leader In All The Major Subfields Of Immunology But Is Only Among The World Leaders In Some Specific Sub-Subfields. On the basis of the results of three benchmarking methods—a virtual-congress survey, citation analysis, and publication counts –the United States appears to be preeminent in immunology. Furthermore, it leads in all four of the subfields examined: cellular immunology, molecular immunology, immunogenetics, and clinical aspects of immunology. That is not a surprising result, given the size of the US enterprise, which writes some 60% of the immunology papers published each year. However, what is of greater interest, given the size of the enterprise, is that in some sub-subfields the United States is only among the world leaders: lymphocyte development and self-nonself recognition, inherited immunodeficiency, tumor immunology, and transplantation and immunosuppressive drugs. The inherent flaws of each method make rigorous and exact assessment of US leadership impossible. However, these approaches do yield an estimation of the present standing of the United States in immunology. Because the exploration of immunology is an international endeavor, the high degree of cooperation and collaboration among US and non-US scientists should be highlighted. Current US leadership has been documented by a number of quantitative and semiquantitative measures, but these measures do not show the breakthrough discoveries that are recognized by such awards as the Nobel Prize (half the immunology awardees were non-citizens). Nor do they reveal that a very significant fraction of the leading US scientists received some of or all their training in non-US institutions, mainly as nationals in other countries; several of these were Nobel laureates for research done outside of the United States. 5.2 Flexibility To Pursue Original And Innovative Research Ideas Has Attracted Both Domestic And International Human Capital. Federal, State, And Private Funding Have All Contributed To A Climate Ripe For This Innovative Research. The United States has been able to attract talented foreign students to be both graduate and postgraduate investigators in immunology laboratories to a greater degree than other countries have been able to attract US students. That is in part due to the research opportunities available within the United States for these students as they seek to advance their

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INTERNATIONAL BENCHMARKING OF US IMMUNOLOGY RESEARCH careers. In the United States, more than in other countries, high-school and college students have the opportunity to gain research and analytical experience by working in laboratories and attending specialized science programs. The NIH has been the major federal funding agency for immunology research. The strength of this system is that it is largely an investigator-initiated, peer-reviewed, and merit-based system of awarding grants. Critically, it is the individual investigator–rather than the department chair or other research colleagues, as it often is in many European countries –that has the authority and autonomy to pursue a specific research interest. Unlike many foreign countries, the United States supports research institutions and medical schools through state governments and private foundations, and this allows the freedom and flexibility to develop innovative research programs. 5.3 Industrial Interests Have Fostered Many Striking Breakthroughs In Immunology. Substantial funding of the biotechnology industry by venture capitalists and other investors has resulted in the successful generation of many products to sell in the international market. Venture-capital financing of the biotechnology industry increased by 11.7% from %697 million in 1996 to $790 million in 1997. (BIO, 1997; BIO, 1998) In addition to creating an economic benefit to the United States, the success of the US biotech industry has resulted in the creation of new jobs for immunology graduates. And, the collaboration between academic and industrial researchers has allowed scientific discoveries to be rapidly developed and commercialized, in contrast with what has been observed in many other countries. 5.4 A Scarcity Of Large-Scale Clinical Trials In Immunology Can Be Attributed To Shortages Of Funding And Of Qualified Personnel. In Addition, Increasing Dominance Of Managed Care Means That Fewer Patients Are Available To Academic Institutions For Clinical Trials. The expense of a large-scale clinical trial often proves prohibitive, especially when there is fierce competition among institutions and between research interests for limited funding dollars. European countries, because of their centralized government control of medical schools and research institutions have been able to support large-scale clinical trials more successfully than the United States. Anecdotal evidence indicates a decrease in trained clinical immunologists to serve as principal investigators for such trials in the United States. Lack of funding and training opportunities has contributed to the growing scarcity. Furthermore, the advent of the managed care has decreased the patient base for this type of clinical research. 5.5 Shifting Federal And Industry Priorities, A Potential Reduction In Access To Domestic And Foreign Talent, And The Increasing Cost Of Maintaining Mouse Facilities Could Curtail US Ability To Capitalize On Leadership Opportunities. Continued US leadership in the various subfields of immunology is not guaranteed. It depends on trends and sudden changes in the United States and abroad in funding, human resources, and infrastructure support. NIH has received increases in its annual budget from Congress, and the increases have resulted in the funding of more investigator-initiated grants in many fields of research, including immunology. The trend of creating multidisciplinary graduate programs at large universities has resulted in competition for immunology graduate students and postdoctoral fellows. In

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INTERNATIONAL BENCHMARKING OF US IMMUNOLOGY RESEARCH addition, there is a substantial decrease in medical doctors seeking to specialize in immunology, in part probably, because of the cost of such an education and the low salary offered during the training period. Other countries, particularly those in Europe, seem to be moving away from the restrictive funding and tight employment environments that have been characteristic of their scientific research institutions. That raises the possibility that foreign students will elect to seek training and jobs in their own respective countries. The loss of talented students in immunology, both domestic and international, would have profound implications for the ability of the United States to maintain its leadership role. One subject of particular concern to the panel was the lack of adequate funding and specific cost-based accounting for maintaining mouse facilities at most research institutions. Because much immunology research involves the use of mice, this resource is critical to the development of the field.

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