Notes from China, Q3 2026

Context: I recently spent 2.5 weeks in China visiting universities, research institutes, clinical sites, companies of all sizes, and investors. Most meetings focused on biotech, neurotech, and AI.

Conventional wisdom my trip corroborated

• US cities feel medieval compared to Chinese cities.
  • I was expecting the cleaner, safer, greener cities with better trains, EVs, consumer electronics, etc. But I was surprised that Chinese cities didn’t feel bleak. I thought that would be the required tradeoff.
• China : Orwell :: US : Kafka
• VC is different in China.
  • Well covered elsewhere: Chinese VCs avoiding losses rather than seeking power-law returns, the role of financial advisors, personal liability for founders, redemption rights, etc.
• Chinese and US tech entrepreneurs are more similar to each other than to either the modal Chinese citizen or the modal US citizen.
  • At least in terms of personality, interests, and motivations. They might be similar in politics, too, but people were less open with me about that.
  • They’re dissimilar in information diet. US entrepreneurs consume US media. Chinese entrepreneurs consume all the media the US entrepreneurs do plus Chinese media. This is mostly an issue of lack of interest, not lack of access, on the US side.
• Chinese companies feel less obliged than US companies to differentiate themselves or define themselves by a core competency.
  • Hence the abundance of near-clone products, even in capital-intensive industries like implantable BCI.
• China and the US seem equally capable at translational biotech and neurotech R&D, overall.
  • The standard caricature of comparative advantage seems right:
    • The US funds a more diverse portfolio of companies and academic projects.
    • China has more efficient regulators and clinical trials and supply chains and lab construction and just generally has more industrial fervor.
    • The US’s market for therapeutics dwarfs China’s (and everyone else’s), and accordingly has larger pharma incumbents and more late-stage capital.
    • Funding for Chinese translational R&D labs and startups is more independent of financial returns than in the US, and more R&D infrastructure is funded (and successfully built) than in the US.
  • China is clearly getting better faster.
  • Biotech/neurotech talent density seems equal in the US and China. But China has more talent mass.
    • China has ~4x the population of the US and something like 2x the STEM workforce.
• Clinical trials are faster and cheaper in China than in the US, with comparable quality and ethical standards.¹
  • Anecdata suggest 2x faster for early trials and 5x cheaper, with large variation between sites and indications.
  • Key reasons for speed:
    • Faster regulatory approval
      • Mainly because G[LMC]P requirements are less time-intensive and because the G[LM]P service industry delivers faster
      • Ethics Committees (ECs, China’s IRB equivalents) anecdotally respond faster to submissions than US IRBs or the FDA, but also require more revisions, so overall a wash.
    • Faster recruiting
      • Larger population
      • More specialized tier-3A hospitals + better transportation infrastructure = aggregation of more patients with the same indication at single sites, especially for rare diseases
      • I was told Chinese patients are more motivated to enroll in trials than US patients for cultural reasons like greater respect for clinician authority and a general pro-technology attitude. No idea how true this is.
    • Everyone, not just sponsors, is graded on speed
      • Clinical trial throughput is a KPI in the performance reviews of nurses, CRAs, hospital and university administrators, doctors, professors – everyone.
  • Key reasons for low cost:
    • Almost everything is cheaper in China
    • Healthcare costs borne by trial sponsors are dramatically lower in China
      • Anecdotally from 5-20x lower total inpatient cost per day
    • Government-subsidized clinical infrastructure
      • Representative example: Tiantan Hospital built a 30-bed dedicated BCI research ward within 1 year, entirely with government funding.

New to me

• In China, big tech companies compensate employees less than startups.
  • Both base salary and total comp. Presumably because startup equity is (perhaps correctly) not valued as much as the credential and security of a big tech job.
• Most Chinese companies have CCP organizations embedded within them.
  • It’s required for companies with three or more CCP-member employees.
  • Not clear whether they matter much.
• Doctors in China are graded on their research output far more than in the US.
  • Doctors are evaluated for promotion based on publications as much as on clinical outcomes, not just at research-focused institutions but seemingly everywhere.
• Chinese startups are quieter.
  • Typically have little or no social media presence, issue few or no press releases, and stay in stealth longer - just generally less legible.
    • Also usually no website, but seems like that’s just because the web is used much less than apps in China.
  • They’re as open as US startups in private communication.
• There’s no nationwide EHR in China.
  • Don’t know why. Seems like the kind of thing China would be great at implementing.
• Exhibition room maximalism
  • The majority of large orgs I visited had dedicated exhibition rooms for visitors, plus tour guides staffing them. And sometimes multiple rooms. I almost never see this in the US.
• Running foreign-sponsored drug and device trials is prestigious for hospitals, for now.
  • One department I visited at Huashan Hospital in Shanghai goes so far as to do its rounds in English every day, for practice, to facilitate work with international partners.
• Differences in clinical practice are the main issues with translating Chinese clinical trial findings to the US.
  • In the past, international partners were chiefly concerned about overall quality and rigor of clinical trials at top Chinese institutions. No longer. The concern now is whether inclusion/exclusion decisions and other clinical assessments will be made sufficiently differently by Chinese and US doctors that results may not translate to the US healthcare system.
• The US may not remain the most attractive market for new therapeutics.
  • Private healthcare is growing in China. The richest 20% of the Chinese population may soon be able to afford US prices (or really US-style private health insurance) for many types of treatment. And China’s NMPA likely can, if it wants to, make itself easier for companies to work with than the FDA. See also the Medical Tourism Pilot Zone in Hainan.
• There are ~10 people at the FDA office in the US embassy in Beijing.
  • WuXi and other big CROs claim they are regularly audited with no warning. But still, only 10 people.
• Nobody I talked to in China, including dozens who work in biotech, had ever heard of a “Chinese peptide.”