There is a long thread in the history of medicine that – should you pull on it – claims that war drove innovation in medicine. These assertions go back to the very basis of western medicine. Hippocrates famously wrote that “War is the only proper school for a surgeon.”

In the premodern and early modern eras, governments released funding and allocated organized labor to few projects, war being among them. While commentators get caught on the war portion of the equation, prying under the surface reveals that it’s truly the funding and concentration of resources that moves the needle for the advancement of medical sciences. Through the nineteenth and twentieth century, governments were among the largest funders of medicine, and much of their funding was spent during times of conflict.

There is little doubt that medicine has made leaps forward during times of warfare in the modern period. The Napoleonic Wars ushered in the concept of ambulance companies. Florence Nightingale brought statistical rigor to the preservation of life in the Crimean War. Imperial expeditions in Sub-Saharan Africa, the Indian subcontinent, and Southeast Asia developed tropical medicine, important forerunners to the modern field of public health. And in their immense destruction, World War I and World War II made major advances in plastic surgery, revolutionized blood transfusion, and scaled production of the first antibiotics.

But medicine’s history, like the history of science, is told in the stories of its successes rather than failures. The most successful drug of the 20^th century, Penicillin, began life as a failure. Alexander Fleming discovered Penicillin in 1928 and by 1930 the mold have been shown to successfully treat infection. Yet Fleming’s lab struggled to purify the mold and to isolate its key chemical components. With additional funding not forthcoming, he put the mold aside.

Ultimately, we know penicillin became a miracle cure that revolutionized the treatment of bacterial infections. And the difference was made not just by war, but what lay behind war: a massive injection of capital and labor into the project by Allied Forces during World War II. Purified in 1939 by a team led by Howard Florey, the team projected in February of 1942 that they might produce 300 courses that year. Enter the Rockefeller Foundation, National Research Council, and Departments of Defense and Agriculture who allocated cash, scientific talent, and mechanical experts to the production process. In 1943, the United States produced enough penicillin to satiate demand across Allied Forces in the Pacific and North African theaters.

In the same way that funding and the application of talent revolutionized penicillin, we can work our way backward to show that the French army funded the first ambulance companies; a Catholic Prelate embraced and helped fund Nightingale’s crucial work before securing resources from the Army’s Sanitary Commission; and imperial enterprises (run by the state and complex corporations) invested significant sums in sustaining the lives of white colonizers in the tropics.

But the ‘funding-as-good-for-medicine’ reasonably underpins more than simply great leaps forward in wartime. The introduction of modern evidenced-based medicine in the United States resulted from philanthropic funding: Johns Hopkins’ endowment of a medical school in Baltimore kicked off the transformation of American medicine from a shockingly backwater profession into a credentialed, scientifically literate one. The Rockefeller and Carnegie Foundations played major roles in pushing scientific medical research and reform in the profession.

After the World Wars, this process continued. Much of the early success against neoplastic cancers came from research powered by philanthropy, notably the Jimmy Fund. Almost nothing has contributed more to the proliferation of available medications, treatments, and research than the expansion of the insured population through the Social Security Amendments of 1965 – an act that created Medicare. Still more recently, the Prescription Drug User Fee Amendments (PDUFA, renewed since 1992), have ‘taxed’ drug developers to pay for expedited FDA review. These drug manufacturers, capitalized and publicly traded, are among have taken over much of the massive expenditures needed to bring novel therapies to market. Underpinning all these changes: funding has allowed access to and allocation of resources on an unprecedented scale to solve humanity’s health challenges. 

Much like a paradigm that war developed medicine, medicine as more broadly fueled by funding does have its downsides. People must necessarily be dying in order for war to advance medicine. Today, the profit motive has become increasingly deleterious to American healthcare and to Americans’ collective health. At the same time, we’ve never had so many available treatments even for diseases of all stripes, even exceptionally rare diseases. Medicine marches onward, and more solutions are in the pipeline.