The US position as a global leader in biomedical research is being undermined. As compiled and presented in this issue of JAMA by Moses et al, one indicator after another demonstrates numerous other countries outpacing the United States in their commitment to research. US medical research spending increased 6% per year from 1994 to 2004 but only 0.8% per year between 2004 and 2012. The United States’ share of total global investment declined by approximately 13% from 2004 to 2012 while the share of Asian economies increased by 7%. Patent output reflects these declines—the United States’ global share of research patents designated as most valuable declined from 73% in 1981 to 59% in 2011.1
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