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.
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.
Thanks, Mike! I was too non-specific with that phrasing. I was referring to China's clinical trial infrastructure; the country has centralized data infrastructure which allows much faster clinical trial recruitment from their network of hospitals (which I would argue is also more centralized than the U.S.'s system, because even though the delivery and financing may be more local, the system as a whole is more national than ours). But point very well taken!
Ah, ok! Thanks for the clarification. Ok, so its data rails and networked recruitment your referring to, ok. In regards to the rest of the system though, respectfully, I dont think that it works to generalize from that to “[the whole system] is more centralized than the U.S.”, afterall, delivery plus financing plus day to day discretion adds up to most of the ballgame, and those being local/fragmented matters a whole lot.
Also, america's is already very centralized in ways, CMS/Medicare-Medicaid national rulebooks set system wide incentives which have shaping effects on a lot of different behaviors even when it wont be billed to Medicare or Medicai , FDA/HIPAA and national compliance regs make system wide constrainers, things like very concentrated investor ownership (PE/markets) homogenize org's management practices across the system, and there other ways too; we're way more centrally directed than from what I gather most people think
don't we all just love fest over the never ending and then even more never ending extentions of patent rights here in the states and the vast beyond. Big Pharma luvs em. That said: I believe science and technology advancements would occur with or withour patent rights. Our curiosity to go beyound the accepted and take the next step forward is in our DNA. Just think of the humanitarian advances we would be experiencing presently if all those smart kids from the trades to the advanced Univ degree were shunted toward making the world a better for humanity rather than going for the big buck seduction of joiing the MIC and finding ways to kill peope more efficiently. just imagine out talented children taking the road less taken.
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.
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.
Thanks, Mike! I was too non-specific with that phrasing. I was referring to China's clinical trial infrastructure; the country has centralized data infrastructure which allows much faster clinical trial recruitment from their network of hospitals (which I would argue is also more centralized than the U.S.'s system, because even though the delivery and financing may be more local, the system as a whole is more national than ours). But point very well taken!
Ah, ok! Thanks for the clarification. Ok, so its data rails and networked recruitment your referring to, ok. In regards to the rest of the system though, respectfully, I dont think that it works to generalize from that to “[the whole system] is more centralized than the U.S.”, afterall, delivery plus financing plus day to day discretion adds up to most of the ballgame, and those being local/fragmented matters a whole lot.
Also, america's is already very centralized in ways, CMS/Medicare-Medicaid national rulebooks set system wide incentives which have shaping effects on a lot of different behaviors even when it wont be billed to Medicare or Medicai , FDA/HIPAA and national compliance regs make system wide constrainers, things like very concentrated investor ownership (PE/markets) homogenize org's management practices across the system, and there other ways too; we're way more centrally directed than from what I gather most people think
I posted a piece... Not exactly abt China but you might find this interesting.
https://www.linkedin.com/posts/ramnarayan_healthcare-healthcareinnovation-medicaleducation-activity-7418737739350687744-_i44?utm_source=share&utm_medium=member_android&rcm=ACoAAAGLc-gBe1taGf1mByvueCa4HcYVxzJ3fxE
don't we all just love fest over the never ending and then even more never ending extentions of patent rights here in the states and the vast beyond. Big Pharma luvs em. That said: I believe science and technology advancements would occur with or withour patent rights. Our curiosity to go beyound the accepted and take the next step forward is in our DNA. Just think of the humanitarian advances we would be experiencing presently if all those smart kids from the trades to the advanced Univ degree were shunted toward making the world a better for humanity rather than going for the big buck seduction of joiing the MIC and finding ways to kill peope more efficiently. just imagine out talented children taking the road less taken.