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John D. McKinnon

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2026-04-29

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2026-04-29

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1. “You can come up with Dooma scenarios where we need a strategic cancer drug reserve because China's days away from putting us off from LGLP. We need like a strategic hot people drugs reserve so that we don't get fat when China cuts us off from the latest GLP ones. I think the optimistic take is like it's just the same it's a replay of the story of the technology in the hardware industry where something is designed by Apple in California and it's made by Foxconn in Shenzhen and everyone gets wealthy everyone gets a cheap iPhone. That's like a kind of a good story to me, Crab. This is a good this is a good smile on your face story.”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

2. “I mean, it just seems to me like what you might, like the obvious bottleneck here is, imagine we live in a world where a bunch of models get, it seems to me that a next step, which is very close, which is just like, can we get to the stage where useful targets are being developed by kind of AI models? And I think once you get to that stage, you're probably going to have years in which the path to taking that target to market still involves going through a clinical trial process that looks pretty much like the clinical trial process today. It sounds like the world you're talking about, creme, is a world in which America might be developing the models that identify the targets. And then they might take those to China to do the clinical trials. And that seems to me to be, I mean,”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

3. “You can automate. Some things with like simulations, you know, this is what Chan Zuckerberg initiative is working on. They're trying to figure out computational bio on the cell level and then on the organ level and then on the system level. So they'll be able to do some stuff. Yeah, like, yes, you still need to do clinical trials. Maybe we'll have like offshore clinical trial shopping. Maybe you'll be able to send a bunch of people to the Cayman Islands to do your clinical trials or something. Or maybe...”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

4. “I think it'll be real for the foreseeable, like the short term, short to medium term future. I think they will continue selling the drugs to America and they will allow us to actually run a lot of our trials in China. This increasingly happening. We're going to make all our trials Chinese because it's easier to run them there. There are good benefits. There are even benefits or drugs you want to prove in China because we can run those trials for cheaper over there. But if they stop us, if they cut us off, then China might just be able to keep pushing ahead because they run cheaper trials and they might be able to cut us off entirely. And we might just lose an edge entirely and like not have any way to catch up.”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

5. “There's also a kind of positive something happening here, which is, and you said at the start, right, you were like, the rest of the world is not pulling their weight in terms of innovation in this space. And China has rapidly come up to par. And in some ways, what you're suggesting seems to me, they kind of pushing past the frontier of the US in terms of drug development here. And the flow-on benefit, the trickle-down benefits, the trickle-down benefits of Chinese drug development, that seems like it's going to be real to me.”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

6. “I mean, like it makes sense to me, Cram, that there'd be certain people and maybe yourself included who would take a kind of, there is a useful lens here, which is the kind of zero-sum lens of global competition, which is to say the US gets a bunch of strategic benefits from being at the cutting edge of medical research. The population of the US gets a bunch of benefits. Americans benefit from being at the cutting edge here. They get the best treatment. They get the fastest. Maybe they pay a little bit more money for it. But, you know, people are willing to pay when you're rich, you're willing to pay for an extra year of your life. It seems like there's that angle and that makes perfect sense. Stepping back, it seems to me like...”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

7. “Their vested interests. They want you to stop building manufacturing plants and stuff. It's actually hard to get a plant set up in the US. And there's more about plants that should be talked about too. Running clinical trials is hard. Paying for drugs is getting worse. China is on the other hand doing everything right. They're deregulating. They figured out a way to fund it. Tidy the lower prices while increasing corporate profits. I mean, and they're targeting the medicines that everybody knows are like good ideas to target. Can America catch up and get ahead is the big question, and the answer is, I honestly have no idea”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

8. “You can lower pharmaceutical profits a lot in the process if you actually are committed to doing it properly, you will do that. You will hurt those profits and the profits are already too low to make this stuff self-financing. And we have too many structural barriers. And if you cut them all down, we still have the issue of the funding. So America faces a lot of headwinds, unfortunately, very few tailwinds. The pharmaceutical profits are actually taking a hit from MFN. The regulators, like at the CBER, they were just like approving designs and then going back and not approving the actual trial results when it got done. That's chaotic. It hurts the ability of companies to plan ahead and actually schedule innovations and all that. You can't make a clinical trial. Why would you invest money in a clinical trial if the regulator is not going to stick to their word and actually approve it if the thing turns out good? Right.”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

9. “And there's a bigger issue with this current administration. This current administration can do all the deregulation it wants. And it might have, it'll have marginal benefits. It will be good. And it'll have great benefits after this administration is out and all that. But the issue is the MFN. The most favored nation pricing is a really huge problem. If you want to actually, and Trump loves this stuff, but basically most favored nation pricing is where you try and make it so America's medications match the peer country prices. So if Germany pays $100 for medication, America will not pay more than $100 for medication. That's the idea. If you do this comparison with a lot of different countries,”

   2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

10. “Yeah, it should be. The only issue, though, is that ultimately you must have the funding element. That is crucial. There has to be money for this. Someone has to pay. In America, people don't pay enough, honestly. It's kind of weird. The returns for pharmaceuticals are below the cost of capital. I mean, just last year, it's actually gotten worse since then.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

11. “There are lots of hints and indications, and they're like, oh, well, we're not spending enough money on these things. And China's regulators are like, oh, great. We'll listen. And we will actually put the effort towards those things. And those things are often really expensive because they're often like, you know, places where they have a lot of new drugs and new drugs tend to be expensive. They target them. They lower the price. They increase the quantity sold. And it leads to more effort in those spaces, which brings down the cost even more and reduces the firm's market power relative to government and makes they can negotiate down further and lower the costing further through competition.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

12. “The clinical trial effort gets distributed to the areas that China is targeting and China is targeting really good areas because it's kind of obvious what we should target. If you ask people who are developing drugs what we should target in order to make the population healthier, they kind of know.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

13. “Kind of daunting. They figured out that part of why America innovates because it pays so much, and they've exploited this mechanism and made themselves better off for it. The government's paying less, people are paying less. The prices are just down across the board for all these drugs. It is amazing. To recap it, they lower the prices. They increase the volume sold. The revenue goes up. The companies end up better off. And there are no spillovers. It's goddamn amazing. It's really incredible. And the areas that they target with their negotiation, much as America's Medicare and Medicaid mechanisms did. Those areas see the biggest increase in clinical trials.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

14. “But they generally don't negotiate, so they charge us more because these have to make up the costs from other countries. We're actually going to make you money. If you are a firm that we are negotiating with and you lower those costs, we're going to help you sell more so that you don't have a reduction in your profit so that you become more profitable and we pay less money and everybody's just better off in general. People are healthier and everything just works better. The firms survive more. It's a good system. They are actually aligning the market and consumer needs. I don't know if it can be done in a free market. It's actually very alarming to me. And there are seemingly not bad effects on competitors for these companies. You look at the spillover effects on competing firms, like the effects on the competing firms' prices or the quantity of drugs they sell and there's nothing there either. If anything, the coefficients are slightly positive. So these other firms that are not in the negotiations don't seem to lose at all.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

15. “Look at that in total. What they do is look on the far right there. And that's what they actually did. Cut down government expenditures on drugs. They also increase the profits of the firms they negotiated down. So generally, when a Western country negotiates with a firm, they lower their profits. They hurt the profits of the firm. And they have to maybe make up some of that money by charging the U.S. who has a policy of not negotiating in general. Until very recently with some of our Medicare, Medicaid stuff we've done under Biden.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

16. “Little like discount rate. So we don't actually know what the real prices are until you get to the point of care and you try and like actually purchase something. China did that and they radically lowered the cost of the drugs. They also increased the quantity of the drugs sold by an even larger amount.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

17. “It sort of is. We also just buy more of everything. Look at, I mean, look at the volume of purchases. A lot of our spending, our volume is on generic drugs, and that's part of why our actual cost delta is not so bad once you count out high dollar items. And it's mostly like a volume thing at the end of the day. But yeah, I mean, we pay more and we pay more often. To figure this out, they've done some incredible drug reimbursement reform stuff. And it's actually been really, really good for them. Basically, you look on the left here. That's the change in price when they negotiate down a drug. So they negotiate down a drug price, which a lot of countries do, and they do it pretty openly. They say what the prices are. Like in other countries, like in Germany, for example, they have hidden...”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

18. “Medicare, Medicaid, when those came about, they led to huge increases in funding for conditions that are commonly affected by Medicare Medicaid stuff. So, like if Medicare is buying a bunch of drugs for blah, blah, blah condition, suddenly the research effort for those conditions increased substantially. Like the elasticities are pretty high there. They lead to big increases in the volume of research for things that matter. America is 4% of the world's population. about 13% of all the drug buying, but it's also more than half of the sales in terms of dollar amounts. So it's huge. And this is a big advantage because like, you know, innovation does respond to the money, and it has to. And trying to figure this out. Actually,”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

19. “I actually think China will get ahead in a lot of ways because they prosecute frauds and the government is like, once they've identified something as fraudulent, they're not going to fund it anymore. And the frauds are going to be out. And they'll find people who are connected to these fraudsters and they'll also cut them off too. They're willing to do things that take a lot of really quick actions and all that. But I do want to get to the most important thing, actually. So, this is the big thing. One of America's big advantages comes from the fact that Americans buy the most drugs”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

20. “Toad David, like a three and a half. What's that? This is it. Yeah, yeah, that's the guy. Yeah, bring him on. I think he'll have a lot to say about fraud and stuff. But Ellie Azar Maslio, the guy who used to run the NIA's neuroscience division, he was the top researcher globally on Alzheimer's and Parkinson's in terms of like his publications and all that stuff. And he basically led to the misallocation of billions of dollars in of. Money that went to like clinical trials and all this stuff and effort. Tons of people spent time trying to replicate his stuff, and it just did not work. So we went down like a tech tree that shouldn't exist. You spent all your level ups on bullshit and it's a lot of money.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

21. “Open them up, you're gonna do pharma stuff. You're allowed to take VC money in China Of course, let's just do that. And they've eliminated corruption in this as well, or they're in the process of it. They are actively jailing people. And I really wish we did in the U.S. Remember that Stanford ex-president, Adolf, the fake Alzheimer's stuff?”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

22. “What are some ways China has done this? Well, it's been, you know, they have tons of reforms. It's not just the clinical trial stuff we've seen so far. That is a huge, huge thing. They've also changed how many fracturing is done, how the assurances from manufacturing are done, the requirements for manufacturing. They've offered people like independence from certain regulations if they're sufficiently innovative. They opened up their capital markets. Historically been pretty close. I don't know if you know this, but like people used to use Bitcoin back in the day to try and leave China.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

23. “And they have traded, you know, they have been careful about trade offs between speed and efficacy, speed and policy goals and how they do this. And they've designed good institutions that produce good. I mean, it's just like classic Ezra Klein liberalism. They really have.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

24. “So, I mean, we're coming up here on like, I don't know, half an hour, 40 minutes, or something like that, creme. So, and I think if we can just kind of like bring everyone up to where we are now, it's like we've talked about this a couple of times, but it's like the US, clearly on a bunch of different measures, China producing a lot more they're kind of pushing more drugs through trials, they're targeting specifically kind of more unique or the frontier of a bunch of different candidates. And there's some kind of, there's like, it seems to me that the reasons for that are, you know, if you go very granular, they're very complicated. But the high-level reason seems to me that they have taken a principled approach to doing some policy reform in the space”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

25. “Some other drug, anyway, it was an active comparator, and they wanted to get the full placebo effect size, they wanted to get the what is the effect versus nothing, basically, versus an inert saline shot. So they have these two trials, and they both have the same inclusion criteria, and everybody in one trial was eligible to be in the other trial. So your control arm for your like novel thing, you don't have to actually have a control arm, just use the control data from that previous trial. That's an innovative control arm. It's an example of it. You don't have to enlist so many people. You can save money by not running the placebo thing again because producing placebo drug is a non-trivial cost. And monitoring those people is a non-trivial administrative bit of overhead. You can cut that out entirely if you have the same eligibility criteria and all that. You could just compare just the treatment group to this old control group.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

26. “Log point increase in the number of trials with innovative control arms. So in China, basically, you're seeing a big increase in the number of trials that have control arms that are totally novel. You can actually take, for example, Eli Lily wants to do this. So Eli Lilly has these two trials. One where they tested dulloglutide and another where they tested Tercepatide against Tersepatide was tested against, I think it was tested against some other GLP1RA. No, it was tested against...”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

27. “Oh, do they leave the trial? Did the doc going to tell us this person died? Kind of don't know If the CDC update of the death index, they could save a lot of money during their trials then. But also, if we had novel methods of designing our phase threes, we could complete them half the time. And the number of these trials that have innovative control arms is radically increasing in China and like not even a thing in the US. We haven't even approved these innovative control arms and stuff.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

28. “Absolutely. And they even have allowed different methods of trial design that are incredibly novel and allow you to get done with a trial quicker. The big proposal now in the US that we've been dealing with for like three years now, or been trying to do is to increase the number of endpoints and to make it easier to monitor trials by updating, for example, the CDC's death index to see do people die at whatever dates. By the way, it's actually surprisingly hard to track deaths. The death index doesn't update immediately on somebody dying. You have to wait. So if you want to like backfill your data from your trial and figure out, oh, we saved lives or we didn't save lives, you got to wait. Some trials actually set up their own call centers to call out to hospitals or call out to people's homes and figure out, are you still alive?”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

29. “It's just raising the walls to try and compete with a cheap generic. And so, like, I mean, again, to contextualize it, it's like if you look at the price of the amount of the percentage of GDP spent on healthcare, it just kind of goes up. If you look at US drug prices compared to the rest of the world, they're quite a lot higher. There are lots of different reasons for that. This is definitely not the only one. But it seems to me like the big picture here is like, this has effects on what you pay for medication. It has effects on how fast you can get treatment for novel conditions. It's actually kind of flowing through all these different channels as well. Is that right?”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

30. “Exactly. My burning through all your capital just waiting on the regulator. Kind of the intent with some of the regulations in the US. Like, we have a regulation called GDUFA, which is the generic version of PDUFA, the prescription drug user fee amendments, where prescription drug producing companies go to the FDA. They pay for the FDA to be the reviewer. They cover the FDA's salaries and all that, and if the FDA approves the drug, the FDA starts getting paid. But with GDUFA, a generic drug that'll compete with the prescription drug, the way it was initially set up is that which was designed by the prescription drug manufacturers, was that if you want to bring a generic drug to market, you have to pay immediately on the review. And the review, there are all these ways that they kept the reviews going longer and longer. So tons of companies would come and propose, I want to bring this generic drug network so I can lower all these costs. And they were like, no, you have to wait. And then you burn through all your capital and your company's gone and there's no actual generic drug production anymore.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

31. “And to contextualize it again, it's like 600 days. I mean, the thing that drives this is if you are a pharmaceutical company, you've invested a bunch of money in developing a drug, a target 600 days might just like make that financially non viable, right?”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

32. “There's all sorts of crazy things that we just don't do that are obvious things that they have implemented. And it's been great for them for the reforms, you can see the review backlog used to be Like almost two years. I mean, Really bad, more than a year and a half. It was incredibly bad. And now it's 65 days as their target, and they're trying to get down even less than that. They're trying to do reviews in like 40 days, which is going to be insane. It's a really good thing that they can. And the way, I mean, it's a good.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

33. “So, you can have one official who does three of the things that used to be given three things that might have been given to three different officials in the past that might have taken way more time. They do so much stuff that has made everything so, so much more efficient. And I mean, it's really every step along the way. It's incredible. They even have a system where you can have companies come and like bid for production of your API, your active pharmaceutical ingredient, all of your stuff. And you can find ways to lower the costs in that way. Absolutely. Yes, it's tons of incredible things. I love every little bit of it. It's really got a lot of stuff that America should work on emulating. The rest of the world should too”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

34. “That's right. Yeah. And they have shortened the review times. They've made everything just go quicker. They made everything streamlined. They've reduced the number of people that everything has to go through.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

35. “And so you're just shortening the approval loops, right? And you're just taking out a bunch of kind of review periods. I mean, this is the nature of kind of any, if anyone watching right now, if you've ever worked with, I mean, if you've ever tried to do some minor renovations in your house and it required some approval from a local, it's not like it's not a criticism necessarily. It's just like the nature of administrative review is you submit something and then an actual person usually has to sit down and look at what you've submitted and they have to check it against a bunch of standards. And that itself is like good social technology because it drives a bunch of good outcomes. But the nature of that process is it takes a long time. If you do something wrong or you don't put the right data in or you label something incorrectly, they have to come back to you and you just go back to the bottom of the pile. And it sounds like you're talking about basically they've streamlined the process in such a way that the actual administrative review process is much faster, but at the same time, they've kind of tried to keep the policy goals of the administrative review process.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

36. “Or phase two early approval. They can approve based on earlier trial results too. They are impressive. They found tons of ways to shorten the process to go from trials to actually approving the drugs.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

37. “Tell here, but it sounds like this particular example that you're talking about, creme, is like how do things work in the US? In the US, you go through a clinical trial throughout that process, you have to provide a bunch of different data and assurances to the regulator. I imagine there's a review period for that. So they say, submit it by this date, we'll get back to you in 60 days. Oh, you got something wrong, we'll have another request for information. That'll take another 90 days to get back to. So you just have all of these kind of like kind of stop points in the process of bringing a drug to market. What you're saying is that the model that China is using right now that they've gone to as part of this reform process is that each, if you're bringing a drug to clinical trial, or if you're bringing venture to clinical trial, you kind of keep all of the records throughout the entire process. You abide by a certain set of standards set by the regulator, but they don't check them.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

38. “Basically, if you were the person bringing a drug to market, you are the holder of the MAH and you have to have these assurances that all your preclinical data is good, that your clinical trials are managed properly, that your manufacturing is done up to some standard that can be audited at the end of the process of the clinical trial. And if the government says, sure, that's good, you can take it to market. They basically make you have all the assurances up to the final phase after which they audit you and you go through some basic audits and then suddenly your drug is going to go on the market. But you don't have to go through a bunch of rigamarole the entire time. Like they take out government inspections and steps along the way.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

39. “Absolutely, absolutely. I mean, they really can. They can do everything so cheaply. They can make tons of infrastructure. They're really amazing. There are so many things I can go over there about the reforms. There's just like, I've written down a lot of stuff here. My favorite thing is the market authorization holder system, the MAH. It is, I think, the coolest part of the reforms in America definitely needs us immediately.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

40. “I mean, kind of a very sort of abundance-pilled country in a lot of ways. Like, in terms of housing, in terms of development, infrastructure, California could use a little bit more Chinese mindset on building high-speed trains, for example. Oh, yeah.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

41. “No, it doesn't work though in America. I really wish it did. Are some cases where it does, but it's quite sadly no. We need IRB reform in America. China has it. They're IRBs, their ethics committees are much more efficient and streamlined than America's, which is. Kind of crazy when you imagine a communist country versus a nominally capitalist country, you would expect the cutthroat capitalists to be the one to go, ah, fuck ethics, but no, the Chinese women say fuck ethics. They go do everything and then we will allow you to do it in the most like streamlined, efficient way. It's very...”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

42. “Oh god, they actually had like lots of diffuse regional stuff going on. They made it. So there's like one national framework. They allow parallel ethics committees. This is actually one of my favorite things. Basically, if you are running a bunch of sites for your trial and one site in one region of the country approves the experiment, then every other site suddenly gets the same approval. So one ethics committee already signed off. So this doesn't work that way”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

43. “Even foreign people, foreign Chinese nationals or just come in and start proposing, here, reform this, that, that thing, that thing, that. And then suddenly they were accepting everybody's ideas and implementing stuff. And they've mostly done it in these four waves. So 2015 to 2017, they started accepting overseas clinical trial data. There's the council harmonization stuff I mentioned earlier. They started accepting stuff from other countries that are part of that ICH. And just like, because they're all good, they're all reviewed. They're all trustworthy countries. Why don't we accept their data? All they required pretty much beyond like, you know, some basic assurances is that you make some effort to show that this drug will work in Chinese people. And then bam, they'll accept the data. They made a very easy process. There's more to it, but it's incredibly easy in general. They streamline their site management. They change the accreditation criteria. So sites no longer have to be like, you know,”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

44. “So it kind of makes sense This is when China really just starts ripping and roaring. They convened a central party meeting where they were like, oh, we want to take suggestions from everybody about how to reform the system. And they genuinely let in like tons of professors, academics.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

45. “Absolutely nuts. And there was no fast tracking until they had this committee meeting in 2009 where they were like, oh, we can start doing that later. And then they basically didn't do it until. Little later than that”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

46. “I got you. Before 2016, China required all their clinical trials to go through CFDA. It's like their version of the FDA, the Chinese FDA, basically, accredited sites in China. They didn't let you run things abroad. They didn't let you take in foreign data, which is a huge impediment because it was hard to run child's in China. And their investigational new drug reviews, that's the reviews to get a new drug, you know, approved and all that, or to start the trial or whatever, anything like that. They took a really, really long time. Like most of a year on average. That meant a lot of drugs actually were taking more than a year. Some were taking like two years to eat review, which is just too much. And the approval time for a novel drug, or actually for any drug, sorry, averaged six years, which is”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

47. “In their biggest year, they had like 400 ish people in the average clinical trial. Clinical trials generally aren't that big, but they're bigger when they're closer to phase three, so China's will probably get bigger in coming years as they have more phase threes. We'll see though. But they run bigger antibody trials. This is another relatively novelty-filled modality. They run bigger small molecule trials. They don't run bigger on everything, but they do run bigger in general. And this helps them to run trials that are more likely to succeed. We often have drugs that get abandoned for reasons to do with these type 1 and type 2 failures. Kind of sad. How'd it happen? This is a part that you want to gain.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

48. “Right, yeah, exactly. And we're more likely to have false positives and false negatives in our trials because they are smaller than theirs. Theirs are less likely to have both. The type 1 and type 2 error rates are both down for China because they run bigger, better trials. And they allow them to be organized across”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

49. “And they're gaining faster actually on totally novel things than they are in general. So they're already ahead of the US when it comes to clinical trials in general. And they're way ahead. They've been ahead for several years when it comes to things that are completely new and novel. The US and China next to each other in terms of totally novel things. China's even more ahead than it was for things in general. It is a rough, rough situation Some other people have documented also that China's trials fail less for statistical reasons because they have bigger enrollments. They make it easier to enroll and they have a bigger population. It's a lot easier to run a big clinical trial in the US that actually just like works.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source

50. “So, for example, You know those new, there were oral small molecule GLP1 drugs now, and they are basically just like a pill form, easily mass-produced version of the GLP1 drugs you're familiar with. Like tons of drugs or small molecule drugs. It's a very broad category of drugs that can be easily produced in a bioreactor and just like shoot a lot of pills in a week. A useful modality. If you want to look that up later, you can, it's fine. Anyway, novel drug compounds. Again, they're ahead in this. Novel frontier drugs, like the first drugs to ever be done for some big category of thing. This includes even mRNA vaccines and stuff. They're ahead in all of it.”

    2026-04-29 · a16z Podcast · The Shift in Global Drug Development · IDENTIFIED FROM THE TRANSCRIPT · source