China's Clinical Trial Boom
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asimov.press
https://www.cbsnews.com/amp/news/nih-layoffs-budget-cuts-med...
https://www.science.org/content/article/nsf-director-resign-...
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...
I would have suggested that they create a high-quality course for introducing westerners to their language instead. It’s the sort of thing that everyone takes for granted that it exists but often doesn’t (where is the Wheelock’s for Spanish these days?) Tonality, pictography, and a highly analytic morphology are all high barriers for any language learners, let alone all three at once.
In terms of government-sponsored resources, the Chinese government has created the Hanyu Shuiping Kaoshi (HSK) tests, and has written standard textbooks for them that are pretty decent. All sorts of third parties have written their own textbooks oriented towards the HSK tests as well.
> highly analytic morphology are all high barriers for any language learners
Analytic morphology is what makes spoken Chinese so easy to learn, in my opinion. There's almost none of the complexity found in Indo-European languages, like number, case, gender and tense. The main barriers to learning Chinese for Westerners are:
* It's not Indo-European, so the vocabulary is almost entirely new.
* Tonality, though this is about the same level of difficulty as memorizing noun genders in Indo-European languages.
* The writing system. Memorizing a few thousand relatively arbitrary characters is difficult.
(European countries killed off 1000 years of Christianity in a single generation at the same time Mao did his giant leap experiment).
Are you talking about the two world wars or something that occurred in the 1960's & 70's?
This is actually a pretty interesting point. Most of the semi-religious customs that were killed off still live on in Malaysia - to the point where I was surprised at how un-chinese China was when I visited.
We’re so unbelievably fucked.
This administration has shown that it absolutely isn't incompetent. It's getting stuff done. Which means it's malice. Guaranteed. We're watching a self made disaster where few will profit, but will profit ENORMOUSLY.
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.
- CAR-T
- CRISPR
- PRIME editing
- Base editing
- Modified mRNA
- PD-1 inhibitors
- On the cusp of personalized cancer vaccines
- ADCs
- Structure correctors
- Targeted protein degraders
- siRNAs
These have all really hit their stride in the past 15 years. Guess where all of them initially came from? Random ass government-funded academic research. Sure, you can split hairs with me on the 15 years and NIH/NSF etc funding, but it’s basically true. We are killing the golden goose…
Edit. My impression of bio tech is that upfront costs are high and timeline for commercialization is long, and the only real biotech firm that I am aware of is Theranos. So I am probably coming from a place of ignorance.
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...
A lot of our worldly meaning is derived from the fact that the clock is ticking. Death of progenitors increases the quality of life for the offspring in almost every single metric, more so for long-lived species that require little protection past a certain growth milestone, and personally I see it as a specific 'human arrogance'; if someone had the idea of "Let's make all the field mice immortal" the first opinion would be "that's ridiculous, the ecosphere would be thrown entirely out of balance, the entire predatory chain would be upheaved."... but when we talk about human immortality it always falls back to "Well, don't you miss dear old Grandma serf?"
I miss her dearly, but the fact of the matter is that the world wouldn't survive long without a death/life cycle for its' inhabitants, and I think that should include the ones that are the most dangerous to the world at large.
p.s. if you need a laymen excuse : i've read enough scifi dystopia tales that begin with the concept of human immortality and the gradual fall of every single moral barrier or raison d'etre ; I don't think that premise is too far from what may happen if humanity is ever given a choice against death.
I still fully believe we need to start discussing how long we want to live. Along-side maybe getting to show my mom my fortunate outcome, Putin could be up for another 25 elections.
We shouldn’t arrive at that moment without an answer to that question.
Besides, death comes for us all. It’s the most natural thing of all. We should be less scared of it, and instead use it to understand we have a limited time we must make the most of.
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?
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.
The western capitalists are now pissed that china didn't "liberalize" and let them take control of the country and are attempting to retaliate. This is why you have imbibed this propaganda that they created.
And this is surely a well balanced opinion and not one shaped by highly ideological forces...
There is nothing particularly wrong with what OP is saying, with the deflationary price wars happening it's very clear they rely on open exports markets to stave off unemployment against their insufficient domestic demand. That itself is only a possibility in a world of free trade fostered in USA, not in a world of mercantalism pre 1945. The ironic thing is that they themselves are trying to suppress the development of India next up in the value-chain.
Anyways, Chinese economists themselves agree for the urgent need to shift to consumption today rather than double down on manufacturing, something that should have done decades ago like Western economists have been urging.
But today, China’s is one of the more expensive labor forces in Asia and yet it continues to dominate manufacturing because of the incredible supply chain they’ve setup and the skill and expertise they have.
- “The debts” - That’s a bit rich considering the U.S. is the largest debtor nation in the history of the world. And debts are not inherently bad, so I’m not sure what your point is. In fact, it’s essential for a growing entity.
- “The Wastes” - Any marginally ambitious effort will have failures. One needs to look at the aggregate, and China, which has pulled a record number of people out of poverty in record time is by all measures had one of the most successful outcomes.
- “The fuel was WTO” - I’m not sure what the complaint is here. Free trade under the WTO has made nearly every nation in the world immensely more wealthy than they would have been otherwise. And yes, this includes China. But it also includes the U.S. which is the richest society in the history of this planet, and until a few months ago was increasing its lead over China. It’s likely the attacks on the WTO and free trade in general by the current U.S. administration will isolate it from world trade and help China close the gap in GDP instead.
- “export” - Yes, an export economy made China richer. On the flip side, it also made Americans immensely richer. Now, the fact that Americans chose to spend that wealth by concentrating it among the richest members of its nation is not a choice China is responsible for.
- “rapid policy changes” - Thisnis not a bad thing as long as the policy changes are thoughtful changes in response to actual changes in our knowledge, unlike whatever the F the U.S. is doing right now.
It's not like it's a secret, either. Their plans are public. You can read them, every five years, as they're released.
I think one should really try to study the actual dynamics of the Qing Dynasty instead of relying on frankly infantilizing stereotypes.
In America, the (false but popular) narrative is that the reason for the revolution was the British tried to tax us on tea, and that was enough to overthrow their regime lol There were plenty of loyalists in America too.
In any case with Opium, Qing estimates themselves only measured around 1% of the population to engaged with the drug, and domestic production actually became more competive than imports at around the 1900s. Nor was the average peasant actually able to realistically afford opium at the time. A large moral panic yes, but USA probably consumes more drugs as a percentage of the population today.
Even with regards to trade, the problem is that Qing had basically no idea or control over any of their finances. Many historians today believe that opium was not really the most signficant factor in heavy trade deficit, but a wider issue of domestic artisans being unable to compete against cheap mass manufactured foreign goods, but we don't know because the Qing didn't even know themselves.
That is to say, it's more accurate to say that Chinese peasants were being dicked over by the Qing (and the Ming beforehand), and foreign imperialism was the symptom, rather than cause of their structural problems. They were authoritarian, corrupt, could not modernize, didn't have control of their finances, all of these factors would have led to their collapse regardless of foreign actions, only that foreign actions revealed the extent of the rot.
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.
https://www.youtube.com/watch?v=VItBlmlWE4U (20 min )
I have no connection with this person at all. Just to make that clear.
It truly felt like China was 5-10 years ahead of any US city.
I’m still not exactly in love with it, I was happy to get back to Seattle (too crowded and the pace of life was a bit hectic, I’m getting old), but the change was definitely there, especially compared to my first trip to Beijing in 1999.
The face thing is still annoying to me and the GFW frustrates me to no end (no, VPN to get around it don’t grow on trees). However, compared to the crap going on in America China is looking very appealing at this point. Of course, my view of China is biased by being mostly Beijing, if you visit southern cities they are much more organized and nicer (I haven’t been to any other city than BJ since 2015 or so). I urge anyone visiting China to consider skipping Beijing.
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.
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.
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.
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.
If you look at the breakdown of any Trump approval/disapproval poll, you'll see who the powerbase is. The billionaires are disposable supplicants, they got on the Trump train late and he doesn't really trust them as far as he can throw them.
That's true of everyone. The billionaires are not disposable, however; they are essential to his power.
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.
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