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Strategy in Bloom's avatar

Nice deeper look root-causing whether flattening U.S.-based biotech R&D investment is related to the market over-heating or missed opportunities to build more sustainable domestic development models.

I appreciate your clarification re: the "centralized" versus "decentralized" nature of the Chinese national health system. Yes, they've very effectively overhauled clinical trial design, approvals, and data-sharing--as well as communication channels with regulators. However, I think the word you may be looking for is "layered". The U.S. has a hyper-transactional, fragmented healthcare system. China's national health 'scheme' is pay-to-play, with the basic tier covering 95% of health costs, but it's up to patients to add specialty care a la cart, layering this on top of their existing plan(s). Agreed that their network design socializes patients to seek care locally, which is another issue unto itself.

One counterpoint I'd like to offer: I'm not sensing that China's gain in biotechnology is a net loss for the U.S. Meaning, I would like to see more partnership, shared learning, bilateral hiring agreements, etc. I don't think innovation in medicine can be an "us" versus "them" game moving forward.

Mike Moschos's avatar

This is well written and interesting and I appreciate you writing it as I found it informative and was only vaguely aware of this angle vis a vis us Biotech struggles. I would have one nit pick though I think there may be a slight error in the essay, and that is here: "Chinese drug development is also much faster because of the... the centralized nature of the health system", there system, in relevant regards, is actually more *decentralized* than our is (well, thats certainly the case generally, but I think it may be the case here on this narrow specific as well)

China’s delivery/financing is often locally governed and administratively fragmented, but trial recruitment can still be faster because patients are concentrated in huge tertiary hospitals, physicians can recruit from very high-throughput clinics, and regulatory/contracting friction is just generally lower anywhere you are. I think that “centralization” isn’t the thing here; throughput + friction is.

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