TY - JOUR
T1 - The Thoracic Surgical Industrial Complex
AU - Starr, Albert
N1 - Funding Information:
government research funds allocated to cardiovascular disease grew from $189 million to $455 million in actual dollars, but remained constant in 1975 dollars (Fig 12).* Of total research funded by the National Heart, Lung, and Blood Institute, 62% is for basic research, 31% for applied research, and only 7% for developmental work.* The artificial heart and left ventricular assist device programs have captured approximately $200 million of these funds over the past twenty years, and are funded currently at approximately $10 million per year, a decline of more than 50% in 1982 dollars (Fig 13) [21]. Another important source of capital is the R and D budgets of large corporations already in the field. They typically spend from 5 to 9% of their revenues on developing new technologies or improving existing ones.+ If the thoracic surgical industrial complex is a $2 billion industry, then between $100 million and $180 million per year are flowing into the system for R and D. The third source of capital is the United States venture capital industry, a segment of the financial world that has grown enormously during the past decade. Total venture capital commitments rose from $0.7 billion in 1978 to almost $3 billion in 1984 (Fig 14) [22]. Medical devices and equipment capture about 4% of the total, and specifically cardiovascular devices represent approximately 1%o f the total,* or $30 million in 1984. The fourth source of capital is new medical offerings,
PY - 1986
Y1 - 1986
N2 - The thoracic surgical industrial complex is an industry worth $2 billion per year and is shaped by six dominant forces, three positive and three negative. The three positive forces are technological innovation, entrepreneurial activity, and the flow of capital and the three opposing forces, government regulation, cost-containment, and the excessive costs of product liability insurance. We are now at a critical time in the evolution of this industry, with growth being enhanced in areas of lesser risk, namely, nonimplantable devices, at the expense of high-risk implantable devices. The future of the artificial heart hinges on the balance between the six forces, and this analysis examines the possibilities for timely development of this ultimate implantable device.
AB - The thoracic surgical industrial complex is an industry worth $2 billion per year and is shaped by six dominant forces, three positive and three negative. The three positive forces are technological innovation, entrepreneurial activity, and the flow of capital and the three opposing forces, government regulation, cost-containment, and the excessive costs of product liability insurance. We are now at a critical time in the evolution of this industry, with growth being enhanced in areas of lesser risk, namely, nonimplantable devices, at the expense of high-risk implantable devices. The future of the artificial heart hinges on the balance between the six forces, and this analysis examines the possibilities for timely development of this ultimate implantable device.
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U2 - 10.1016/S0003-4975(10)60503-6
DO - 10.1016/S0003-4975(10)60503-6
M3 - Article
C2 - 3527091
AN - SCOPUS:0022450413
SN - 0003-4975
VL - 42
SP - 124
EP - 133
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -