I have written previously on the so-called ‘golden age of medical research,’ [1] which coincides roughly with the first two decades of my life – 1950-1970. The premise of a golden age entails the conclusion that it is followed by a less spectacular age where marginal returns are lower per unit of input – say per researcher. So, where does the truth lie – is research becoming ever more efficient, or is the productivity of research declining? This subject has been carefully examined by a number of scholars, most recently by Bloom and others.[2] First they looked at aggregate supply of researchers and economic output across the US economy, and they found a relationship that looks like this:
So, productivity per researcher appears to decline with time and does so quite rapidly – the graph uses log scales. The drop in unit productivity has been fully compensated by growth in the number of researchers.
Given the obvious problems of studying this phenomenon at the aggregate level, the researchers turn to individual topics, such as number of transistors packed onto a single chip. It turns out that keeping Moore’s law going takes a rapidly increasing number of researchers. However, diminishing returns are not just observed in electronics, the authors found the same phenomenon in agriculture and medicine. Research productivity in the pharmaceutical industry is one-tenth of what it was in 1970, and mortality gains have peaked in cancer and in heart disease. To some extent one can see this effect in the number of authors of medical papers, such as those in genetic epidemiology – they often run literally into hundreds. It would appear that ideas really are getting harder to find and/or when found they portend smaller gains.
I have previously made the obvious point that improved care reduces the headroom for future improvements.[3] Of course, economic growth and further improvement in health still turn on new knowledge and technology without which the supply-side of the economy must stagnate. The phenomenal growth of some emerging economies has been possible because of the non-rivalrous nature of previous discoveries made elsewhere. But we need to continue to advance for all that advances are hard to make. One of these advances concerns making optimal use of existing knowledge, and that is where CLAHRCs come into their own – we trade in knowledge about knowledge.
— Richard Lilford, CLAHRC WM Director
- Lilford RJ. Future Trends in NHS. NIHR CLAHRC West Midlands. 25 November 2016.
- Bloom N, Jones CI, Van Reenen J, Webb M. Are Ideas Getting Harder to Find? Centre for Economic Performance Discussion Paper No. 1496. 2017.
- Lilford RJ. Patient Involvement in Patient Safety: Null Result from a High Quality Study. NIHR CLAHRC West Midlands. 18 August 2017.
NIHR CLAHRC West Midlands News Blog 
Excellent, thought provoking read for a Friday morning. Interesting link to article focusing on problems for present day researchers… The 7 biggest problems facing science, according to 270 scientists https://www.vox.com/2016/7/14/12016710/science-challeges-research-funding-peer-review-process?
But Richard, how do you explain the phenomenon that almost everyone is convinced that the best developments in the world happened in their lifetime and more remarkably in their young years, rendering all past and possibly future generations superfluous?
In the West, hyperregulation and managerialism sap the morale of enthusiastic researchers. The closed loop of peer review ensures that researchers have to spend more time begging for money than doing their research. The NHS has been shut down for research and the era of the “enthusiastic amateur” – which was a great strength in UK is over !
In China you need one ethics approval and you are in business. All patients agree to research when they enter the hospital on one form. Underdeveloped economies will outperformsclerotic, Western research efforts for the foreseeable future.
I strongly agree that 1950-1970 was a golden age. In our specialty the basis for understanding preeclampsia was laid down in 1953 (GJ Sophian preceded by J Trueta in KJ Franklin FRS labs). BUT we “lost” the morphology of the autonomic nerves when we started using formalin in post-1945 medical schools. Most disease results from injuries to autonomic nerves including the most of OBGYN, andnow hypertension (The arteriolar injury in hypertension. See AmJMed 2018).
Sowecould enter anew “golden age” if we took DO Burkitt’s advice and concentrated on simple, lifestyle sources of disease eg diet, bowel habit, exercise, posture, gait and childbirth rather than (epi)genomics !?!