You only bothered to read the abstract, and really failed to understand the paper. The paper makes a legitimate case that private industry provides vastly more direct financing for the later stages of drug development, particularly clinical trials and regulatory approval. However, its methodology arguably understates the public sector's broader contribution because it primarily identifies public involvement through NIH funding that can be directly linked to patents and particular drug candidates. This favours contributions that are easily attributable and commercially identifiable, while excluding much of the public sector's upstream research: basic biology, disease mechanisms, target identification, experimental techniques, databases, scientific infrastructure and researcher training. Much of this research is deliberately published rather than patented, yet can be essential to the subsequent development of a commercial drug. The paper also risks comparing fundamentally different types of investment. Private companies generally enter the process when there is a potentially commercially viable candidate and then spend enormous sums on optimisation, clinical trials and regulatory approval. Public research often operates much further upstream, creating a body of scientific knowledge from which numerous companies can subsequently draw. Consequently, measuring the private sector's expenditure on the successful candidates while measuring only patent-linked public expenditure can make the public contribution appear disproportionately small. Studies using a broader methodology—particularly by tracing NIH-funded scientific publications and the underlying biological targets—have found public research associated with essentially all recently approved drugs, suggesting that the public contribution is much larger when the scientific foundations rather than just patented products are considered. There is also a causality problem with interpreting the paper's results. The fact that greater private investment is associated with a higher probability of approval does not necessarily mean that private investment itself explains the success: companies naturally invest more heavily in drug candidates they already consider promising. More fundamentally, the paper's $670 million of NIH funding versus $44.3 billion of private funding should be understood as a comparison of traceable, drug-specific financial inputs, not a comprehensive measure of each sector's contribution to innovation. The paper therefore provides useful evidence about who finances the expensive final stages of development, but is much less capable of answering the broader question of who created the scientific knowledge and reduced the technological uncertainty that made those investments possible. In healthcare, industry really struggles with the idea of zoonotic diseases. These are infectious diseases that have crossed the species barrier. About 60% of infectious disease in humans started in another animal. Industry only funds when it can make them money, naturally. Sars-Cov-2 is an example of a threat agent that crossed the species barrier and affected us all. Money was thrown at the problem, and frankly, it wasn't industry then coming up with the solutions. Ebola. 2014-2015, there wasn't even an approved test to diagnose this. Even now, there are 3 tests on the market, maybe 5-6 in development. There is no money to be made in diagnosing and treating Ebola. When you laud industry, remember, healthcare is driven by people's pain, not consumer choice, At the heart is life and death, not moolah. The private sector has a role of course. The entire Pharma sector was created because of D-Day; Fleming's discovery of penicillin was made into the war winning combat medical treatment thanks to two Aussie chemists working for an unfancied American chemical Merck (formally German until the US government forcibly nationalised the US arm after WW1).
