Notes from China, Q3 2026

Conventional wisdom my trip corroborated

• US cities feel medieval compared to Chinese cities.
  • I was expecting the better cleanliness, safety, 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 loss 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 that was harder to tell.
  • 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 their core competency.
  • Relatedly, they’re happy to directly compete with competitors with nearly-clone products.
• 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 feels the same between 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 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 are:
    • 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 seem to meet more often than US IRBs or the FDA, but also require more revisions so might be a wash.
    • Faster recruiting
      • Bigger population
      • Fewer, more specialized hospitals + better transportation infrastructure = aggregation of more patients with the same indication to single sites
      • Patients allegedly enroll at higher rates because clinical trials are regarded more like exclusive private beta tests rather than risky opportunities to be a doctor’s guinea pig. No idea how true that is.
    • Everyone, not just sponsors, are graded on speed
      • Clinical trial throughput is an explicit KPI for promotion for nurses, CRAs, administrators, doctors, professors – everyone.
  • Key reasons for low cost are:
    • Everything is cheaper in China
    • Healthcare costs (borne by trial sponsors) are dramatically cheaper in China
      • 10-20x cheaper total inpatient cost per day seems about right
    • Government-subsidized clinical infrastructure
      • Representative example: Tiantan Hospital built a 30-bed dedicated BCI research ward in the past year, fully government funded.

New to me

• Big tech companies compensate employees than startups in China.
  • Both 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 clinical outcomes, not just at research-focused institutions but seemingly everywhere.
  • Apparently not surgeons, though.
• Chinese startups are quieter.
  • Typically low-to-no social media presence, few-to-no press releases, 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.
  • Presumably because doing so offers no advantage in their VC or talent ecosystem.
  • They’re as open as US startups in conversation or text.
• 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 we visited had dedicated exhibit rooms for visitors, plus tour guides staffing them. And sometimes multiple rooms. I almost never see this in the US.
• Running foreign 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 their rounds in English every day, just for practice.
• Differences in clinical practice are the main issue with transfering Chinese clinical trial findings to the US.
  • The quality of clinical trials at top Chinese institutions really isn’t in question any more. The concern is that inclusion/exclusion criteria will be evaluated sufficiently differently by Chinese and US doctors that results may not translate to the US healthcare system.
• The US may not remain the biggest healthcare market.
  • 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 20% of China’s population is 80% of the US’s population.
• There are ~10 people at the FDA office in the US-Beijing consulate.
  • WuXi and other big CROs get audited all the time with no warning. But still 10 people isn’t a lot compared to TKTK in the US.
• Nobody I talked to in China, including dozens who work in biotech, had ever heard of a “Chinese peptide.”