Sustaining America’s Health Innovation Leadership in an Era of Misinformation and Global Competition
By: Dr. Steven Farmer - Senior Partner, ABIG Health
For decades, the United States has been the undisputed global leader in healthcare research and innovation. Our academic medical centers, biotechnology firms, pharmaceutical manufacturers, and regulatory and reimbursement institutions have collectively driven breakthroughs that transformed the practice of medicine worldwide. From gene-targeted therapies and immuno-oncology to mRNA vaccines and AI-enabled diagnostics, much of the world’s medical progress has been shaped by discoveries that originated here.
The question now is whether that leadership is sustainable.
The answer should be yes. Health innovation is not only central to our national identity, it is a core pillar of our economic engine. Healthcare accounts for nearly 20% of U.S. GDP. Biomedical research and drug development are strategic sectors that shape global influence. Public health preparedness — and the ability to rapidly develop, test, and deploy medical countermeasures — is undeniably a matter of national security.
Maintaining leadership in this space is not optional.
Sustaining leadership requires acknowledging the pressures now working against us. And some of those pressures are self-inflicted.
The Erosion of Trust and Institutional Capacity
What concerns me most is the corrosive spread of misinformation, politicization of science, and deliberate undermining of public institutions. During the pandemic, we witnessed the consequences of fractured trust: skepticism toward vaccines and clinical trials, hostility toward academic researchers, and reflexive dismissal of scientific consensus. These dynamics did not disappear when headlines shifted. They have seeped into how research is funded, how regulatory decisions are interpreted, and how clinicians and scientists are able to do their jobs.
The result is an environment in which researchers, academic centers, clinicians, and even patients must operate on unstable ground. Conspiratorial thinking disrupts rational policy debate. Harassment and public targeting of scientists discourage new talent from entering the field. And policymakers responding to political pressure rather than evidence undermine the regulatory stability that innovation requires.
If we weaken our institutions, we weaken the infrastructure that makes innovation possible.
Clinical Trials as National Strategic Infrastructure
One example of our weakened system is clinical trial capacity. Clinical trials are often framed as an economic component of drug development, but they are also a national security asset. Our ability to respond rapidly to emerging threats such as pandemic pathogens, bioterrorism, novel chronic disease dynamics depends on having a clinical trial infrastructure capable of enrolling patients and generating evidence at speed.
The United States has historically held a strong position here. Investments in electronic medical records under the HITECH Act, fee-for-service billing patterns that encourage documentation, and improved interoperability have made real-world data research increasingly feasible. Under the 21st Century Cures Act, the FDA advanced frameworks for real-world evidence generation that gave the U.S. a strategic advantage in regulatory science.
But our advantage is not guaranteed. China has dramatically accelerated its clinical research capacity, with a 26% increase in trial registrations last year and growing success in securing FDA breakthrough therapy designations. China is investing aggressively in trial site scalability, centralized regulatory coordination, and shortened site activation timelines. Meanwhile, many U.S. trial sites are slowed by fragmented systems, variable contracting procedures, staffing shortages, and rising operational costs.
The answer is not to lower safety standards. The FDA’s role is to ensure that medical products are safe and effective. Accelerated pathways already allow earlier market entry with some uncertainty, provided that post-market evidence confirms safety and clinical value. But too often, post-market studies are delayed or quietly abandoned, and enforcement is insufficient. If we want to maintain global credibility, especially in the face of international competition, we must reinforce — not weaken — standards for ongoing evidence generation.
The Emerging Biopharma Squeeze
Innovation today is driven largely by small and mid-sized biopharma companies, not legacy pharmaceutical giants. These emerging companies depend heavily on contract research organizations (CROs) and contract manufacturers to move therapies from concept to clinic. But many smaller firms lack deep regulatory expertise, clinical operations capacity, or commercialization planning experience — a problem that makes the transition from breakthrough idea to reimbursable therapy perilous.
CRO consolidation has created mixed outcomes. Larger CROs may offer superior sophistication and operational discipline, but consolidation also raises costs and reduces flexibility. As operating costs rise and early-stage capital tightens, fewer small innovators can sustain the journey required to bring new therapies to patients.
And if we lose emerging biopharma, we lose the engine of therapeutic discovery.
This is not just a market issue. It is a national strategic vulnerability.
Talent: The Most Fragile Asset
Our academic health centers, which historically have been the backbone of U.S. research and training, are facing severe stresses. NIH funding instability, reductions in indirect support for research infrastructure, rising uncompensated care pressures, and insurance reimbursement constraints are converging. These financial pressures threaten laboratory capacity, training programs, and the protected time needed for discovery-driven research.
At the same time, uncertainty in the research environment discourages the next generation. Postdoctoral researchers, clinical research coordinators, and data scientists are questioning whether academic careers are viable. Many are opting for industry roles or leaving the sector entirely.
Talent is the foundation of innovation. Without it, everything else collapses.
A Path Forward: Rebuild Trust, Reinforce Institutions, Modernize Infrastructure
If I could prioritize one investment, it would be rebuilding the institutional scaffolding that supports our research and regulatory ecosystem. That means:
Re-establishing trust in scientific and regulatory institutions through transparency and communication, not defensive positioning.
Reinforcing FDA and CMS authority with stable staffing and predictable guidance publication. Uncertainty is the enemy of innovation.
Treating clinical trial capacity as national infrastructure and funding it accordingly.
Supporting emerging biopharma with targeted scientific, regulatory, and commercialization resources, not just capital.
Stabilizing academic research funding and indirect support to protect training pipelines and laboratory capacity.
Advancing responsible AI integration in research and clinical trials to improve efficiency without compromising safety.
Sustaining leadership in healthcare innovation requires commitment to the long view. Innovation does not flourish in a climate of instability, cynicism, or short-term political gain. It requires faith in the value of evidence, a respect for scientific process, and the willingness to invest in institutions that serve the public interest.
The United States still has the talent, infrastructure, and capacity to lead. Whether we continue to lead will depend on whether we choose to protect the systems that made leadership possible.
