China's Clinical Trial Boom

https://www.asimov.press/p/china-trials

by surprisetalk • 1 year ago

160 83 1 year ago

Veedrac• 1 year ago

So much of policy success comes down to doing obvious and reasonable things, and most of the problem is how to incentivize making those choices. For all China's flaws, they've figured this out.

The best news here is that we might finally have a prosaic means to escape our modern-era applied biotech stagnation, the same way solar has appeared as a means to kick the feet out of traditional energy sources. China is pretty new to being an R&D powerhouse, but there are few more worthy causes.

narrator• 1 year ago

The best outcome for the current China/U.S conflict is lots of peaceful competition that forces each society to innovate.

kccqzy• 1 year ago

Well during the Cold War with U.S./USSR conflict there was a lot of competition that heralded many new technologies, especially the dual use technologies that are good for both civilian and military uses. I can imagine something happening again if the U.S. had good leadership.

henry2023• 1 year ago

One of the parties involved already decided they don't event wanna try to compete.

tway2233• 1 year ago

China’s success is not because of the policies but rather despite of them. Though not sure how sustainable these successes would be.

tehjoker3• 1 year ago

How on earth can you possibly claim that when China was a peasant society that was dicked over for a hundred years by western powers addicting them to opium? Obviously their careful planning and industrialization strategy is working.

munchler• 1 year ago

Meanwhile DOGE has cancelled more than $2 billion in federal research grants. The US is shooting itself in the foot when it should be competing at its best.

https://www.cbsnews.com/amp/news/nih-layoffs-budget-cuts-med...

whatshisface• 1 year ago

The administration is also pressing for a 55% budget cut to the National Science Foundation. The NSF is the primary funding agency for engineering, physics, mathematics, chemistry and computer science, among many other fields. If there's any doubt about the seriousness of that situation, the director has resigned over it. When some worried that US world leadership in physical and life sciences may be surpassed in a generation, I doubt anyone realized it could happen in one year.

https://www.science.org/content/article/nsf-director-resign-...

ImaCake• 1 year ago

I doubt anyone realized it could happen in one year

I mean China has been modernizing their academics for a long time. See "Double First-Class Construction" [0]. But it's worth remembering that they did a lot of damage during the Cultural Revolution.

0. https://en.wikipedia.org/wiki/Double_First-Class_Constructio...

saturdaysaint• 1 year ago

Fascinating, then, how the head of DOGE has deep financial interests in China. It’s really not out of bounds to suggest that his benefactors could’ve pulled some strings to kneecap the US.

ToucanLoucan• 1 year ago

Never attribute to malice what is equally explained by incompetence, and these morons have been openly saying this is what they want to do for years.

We’re so unbelievably fucked.

forgotpwagain• 1 year ago

Indeed, now is the moment to step on the gas in biotech. The past 15 years have been nothing short of extraordinary in the field. We finally have the tools needed to effectively measure biology, manipulate biology, and increasingly predict biology. More recently, we have been able to turn more and more problems into computational problems.

With all of this coming together, we should be accelerating both public and private investment in biotechnology because we're getting closer and closer to transformative therapies. But...we're failing to rise to the occasion and meet the moment.

EMIRELADERO• 1 year ago

Could you give some examples/directions for interesting things that have popped up in the period you're mentioning? Sounds like a fun time.

kwere2• 1 year ago

biotech, outside of curing most illnesses (except trisomy of 21 or others) is a very touchy field that most politicians would steer clear

mchusma• 1 year ago

Without commenting on the cuts themselves, this article suggests its regulatory reform that is needed to keep up.

buyucu• 1 year ago

China is having a boom in everything, not just in clinical trials.

kudalf• 1 year ago

There’s no evidence that “Chinese trials” or intentional testing on humans caused the outbreak. Investigations by the World Health Organization and independent scientists have not found proof of deliberate origin.

goalieca• 1 year ago

You seem like a bot given 1 comment in 3 years and it was about this. Your AI misinterpreted the GP and responded to something not asked.

refurb• 1 year ago

If you follow the economic news China has some severe structure problems that it’s going to have to solve.

Huge debt overhang, much of it “hidden” that is dragging down growth

The real estate problem still isn’t solved and a big reset of prices is going to have a big impact on the economy

China placed a big bet on “key industries” under the theory “supply first then we find demand” which isn’t panning out well with tariffs

This is showing up in the stock market which rent saw a 50% decrease

And economic growth has been a weak 5% when they need 9-11% if they hope to avoid the middle income trap

All while the population is rapidly aging and shrinking at the same time

mmooss3• 1 year ago

Competing with it is a problem for conservativism. Some admittedly loose reasoning:

Conservativism preserves currently widely accepted structures, including ideas, by ridiculing and excluding new ones; social structures, by outlawing / persecuting / demonizing new ones as a threat to 'our traditions' and 'way of life'; businesses, through tariffs and other anti-competitive measures - the House GOP is considering a bill that reduces antitrust powers, for example; existing economic sectors, by government picking winners and funding them, limiting the economy to what is popular and that the government already understands, such as manufacturing; etc.

Remember the land of the individual, of personal freedom, of opportunity, that by its culture generated invention and innovation that other places, without that culture, couldn't match. What China, which is limited by central control, is doing is copying well-established innovations - a biotech industry that relies on clinical trials. Cutting edge stuff - decades ago.

What has made the US successful is creating, innovating, and moving on to the next thing - things the government and most of the public are far behind on. Look at the boom in the IT industry over the last several decades (also no longer cutting edge except in limited ways).

How can that happen now? The US has currently embraced relatively extreme conservatism. People are afraid to offer challenging ideas, and make their money from rent and from squeezing revenue from old ideas (the stereotypical private equity model). They can't go anywhere except by pleasing the oligarchy, now including the government.

vladms• 1 year ago

While agree with the whole analysis, I do wonder if most/enough/all the ones supporting the regime change in US are really conservatives ("embraced extreme conservatism") or they just feel/are "left behind" hence they want any change. People might not care who is in power (although they will suffer the consequences), but if after 4 years they do not live better they will say "let's change" - without really checking what is the alternative...

In the end, alternation of rulers is probably on average healthier than having the same guys over and over, but it is no guarantee of success.

theLiminator• 1 year ago

I personally think you're right. I think that in general a lot of people want change for the sake of change if they're unhappy (or often even if they're happy).

mmooss3• 1 year ago

That hypothesis goes back to Trump's first election. I think it appeals to fears and stereotypes that working-class white people are fundamentally racist and don't care about democracy and freedom, which is why it makes a strong impression - people remember it and repeat it. IIRC, the data from the elections doesn't support it (but I don't have the data).

I think Trump's real powerbase is a wealthy elite, including those who have great influence over the business world and, most critically, over the flow of information, including on Facebook, Instagram, and X.

dlisboa• 1 year ago

Remember the land of the individual, of personal freedom, of opportunity, that by its culture generated invention and innovation that other places, without that culture, couldn't match. What China, which is limited by central control, is doing is copying well-established innovations

They don’t seem to be limited by it at all and in many areas of high tech innovation they are years ahead.

It’s very hard to argue that their EV market, for instance, is not an example of competitiveness driving innovation, which is supposedly the hallmark of the free market.

firejake3082• 1 year ago

Their EV market is pretty competitive, and they have multiple brands all releasing EVs. Nio, BYD, and Xpeng come to mind. Compare to the US, where we only have one EV maker with a decent market share (Tesla) which has stagnated in innovation. My argument is that where China has succeeded, it has done so by adopting Western values like free-market competition (see the reforms of Deng Xiaopeng) and where the West has failed, it is due to monopolization and stagnation/decadence.

miki123211• 1 year ago

China's population is almost twice that of the US and EU combined. If what you're lacking for is patients, there's no better place to go to.

Not only that, but we're also a lot more obsessed with patient privacy. If somebody dies of cancer, there's no headline news about them dying of a cancelled trial, even if that's actually what happened. If patient data leaks, there's both a PR nightmare and legal consequences for the institution. That drives priorities.

I wouldn't be surprised if (some) Chinese researches are allowed to SELECT * from citizens where disease = 'bone_cancer', whereas researchers in the US have to send people to waiting rooms in hopes of catching an eligible patient[1]. Unless this gets changed, things won't get better.

We really need to start optimizing for min(deaths) instead of min(bad_pr) or min(outrage). That's a genuinely hard problem in a democratic society that respects the right to free speech (which, to be clear, is a very good society to live in IMO). In a way, it's a good problem to have.

[1] is a really good and accessible overview of why drug trials are so hard and what could be done to make them easier, it's worth checking out for anybody who wants to dive deeper into the subject.

[1] https://www.complexsystemspodcast.com/episodes/drug-developm...

kulahan2• 1 year ago

I strongly disagree. There is no need for humans to be immortal, and there is nothing wrong with tacking healthcare research to public opinion at a bare minimum. If nothing else, it helps ensure our medical care doesn’t veer too far off track.

coderatlarge3• 1 year ago

please consider revisiting this post when/if you or a loved one are on the receiving end of a terminal illness diagnosis. which i don’t wish on anyone.

dangus• 1 year ago

This might just be the dumbest thing I heard all day.

I have a family member who got cancer in their 50's and they've now lived 25 years longer than how long they would have lived without healthcare research. They would have been dead if it was 10 years earlier and the research wasn't where it was.

They literally gained a third of a lifespan just because someone decided to spend money on research. They would have never seen their kid get married or have their own kids.

Now multiply that by hundreds of thousands if not millions who have the same diagnosis.

Nobody's trying to be immortal, we're just trying to live the fullest lives possible and give ourselves a good amount of healthy years.

If you think healthcare is a waste of money I am not sure what you think is more important than your health, maybe an AI app to create shareholder value?

fluidcruft• 1 year ago

One of the leading researchers in MRI methods development has been doing collaborative work in China for many years. About 5 years ago I was chatting with him about how he's in China so much lately and he told me that the great thing about China is he can get an idea rolled out en masse to over 100 scanners(!!) and have multiple hundreds of case results in various different diseases in less than a month(!!!). This is shocking speed and quantity of data as these things go. Who wouldn't prefer to work in that environment?

holoduke• 1 year ago

Just a walk in a random big city in China reveals how fast they are progressing. The speed of things changing is ridiculous. In almost every field they are getting better. And fast. Thats what you can achieve when your country has 40 years of mass production experience. The thing I hope most for is that China gets its own high performing chips so that companies like Nvidia really get a competitor.

bamboozled• 1 year ago

Interestingly the allure to visit China and see the progress is becoming more compelling. Meanwhile people are afraid to visit the USA.

aurareturn2• 1 year ago

If you check my post history, I kept encouraging HN posters to go to China to see for themselves. The vast majority of commenters here have never been to a China or have never been recently. It’ll change how they see China instantly.

The problem with many HN commentators on China is that they view China through a western news propaganda filter. Therefore, they think China must be stealing or cheating to get ahead. If they go see for themselves, the moment they step off the plane, they’ll see that major Chinese cities are 5-10 years ahead of any US city. In other words, China is leading in many areas, not stealing or cheating. They have no reason to steal when they’re leading already.

seanmcdirmid4• 1 year ago

The material engineering for advanced chip and jet turbine production are the two things that China has had to build from scratch, so it will take it a bit longer to reach parity in the west. They get either performance or price down right now, but not both at the same time. Maybe 5 or 10 years? Everything else they have the engineering skill to advance quickly.

monero-xmr2• 1 year ago

If China actually makes pharmaceutical breakthroughs, the West should immediately steal them and invalidate any claims of patents. They do not respect US intellectual property rights

tway2233• 1 year ago

The west actually had quite some deals with them recently. If not for the trade war there could’ve been a lot more. To some extent it is like the Temu vibe.

WorldPeas2• 1 year ago

..with what industrial scale? It would work for internal markets maybe but I figure the Chinese industrial base applies to more than plastic toys

monero-xmr2• 1 year ago

Copying pharmaceuticals is ridiculously easy. Only patents protect them

nujabe• 1 year ago

What’s new? America is cooked.

pappyvanwinkle• 1 year ago

Interesting piece, but I think it is helpful to highlight some points not addressed that provide meaningful context. Though the US system is not perfect, I think we need to acknowledge the US does have a robust, enviable biomedical / regulatory ecosystem, and lots of thought and effort have gone into curating the system that we all enjoy today. To engage with a select few of the points made:

1) Author cites that China introduced priority review mechanisms, conditional approvals, and accelerated timelines to streamline approval pathways. They fail to mention that the US helped pioneer these same mechanisms and that they are currently, actively, in use. We DO have priority review vouchers to incentivize investment in orphan disease, conditional approval pathways, and breakthrough designations for drugs addressing unmet needs to name a few. The US has been, and continues to be an innovator on these topics and credit should be given here - this stuff isn't new to us and there is a rich history of attempts to incentivize innovation ranging from offering prizes for cures to disease, to purchasing experimental therapeutics in advance of approval to ensure sponsors have the cashflow to continue development.

2) Regarding acceptance of foreign data, whose data do you think the rest of the world wants to use by designing their policies the way they have? Many countries are willing to accept foreign data because that includes data generated in the US, where historically and presently, standards are very high and the research infrastructure is well-supported (recent events notwithstanding). One need only look at the story of Dr. Frances Kelsey and thalidomide to understand why the US has gone to great lengths to ensure a high bar that is carefully maintained by its own FDA's standards. This is NOT to say great data isn't generated elsewhere and there are examples where ex-US data has been used to support US approval of promising drugs (particularly in areas of significant unmet need, for example, neurodegenerative disease), but there is rhyme to the reason that goes beyond the argument that the US is antiquated in its approach. That said, one can acknowledge there is a geopolitical component that may wax and wane in relative importance depending on the current political climate.

3) Citing the Lunar trial actually highlights the robustness of the US biomedical enterprise rather than detracts from it - that trial was conducted in patients with stage IV NSCLC after they progressed on platinum therapy. In the US during the enrollment period, ICIs like pembro were being approved as first-line monotherapy displacing platinum-based therapies. So the problem there is when practice changes, you're going to 1) have a harder time finding patients that are progressing on the thing that is no longer first line and 2) remember the intervention arm was ICI + TTF...so you can't intervene when people have already received the drug class that is part of your intervention. Saying they couldn't enroll because of bad infrastructure is like saying the apple store is bad at enrolling customers with dead Iphone 10s to trial your combo therapy when most of the people they see have Iphone 15s. You need to enroll then where most people coming through have iphone 10s and this is precisely why they enrolled a significant proportion of patients ex-US because the standard of care elsewhere had not yet changed.

Props to the author for bringing up the important question of US competitiveness in drug development. But let us not forget that we have an enviable biomedical apparatus for a reason - the US has a strong track record of high standards and innovation because we have a good many rigorous, scientifically-minded folks who work on improving it all the time. It's not perfect, but if we don't call out the good, pioneering work that has been done here, then people may feel justified in questioning if anything has been done at all. One should not get the impression we're just waiting around to get hyperdunked or just lucked into the good things we do have.

China's Clinical Trial Boom

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