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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. “I mean, the thing is, all the excuses are kind of bogus. If we can cure a family of a horrible, debilitating disease for all time, why don't we? I think we're slowly coming around on this society and we're going to do that because China is going to do that in part. I think that might be a little bit of our motivation to do that. But they don't have as much resistance to that. So they are willing to actually cure families forever, which is something we can't do in the West. Well, another thing is they are actually ahead in antibody based drug trials. They are also ahead, and antibodies have been like a big thing in recent years. They're really good drugs. Small molecule drug trials even hit in that. Those are very easily produced like pills and stuff. When you just look at all novel drug compounds, again, they are small molecules.”

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

  2. “Get to that. This first third of the presentation is basically just documenting that China is ahead and they are ahead not because they're copying anybody, but because they're really innovating. And they really are innovating. And they have another advantage when it comes to these gene therapies. In the US, we are banned from offering gene therapies that do germline changes, meaning that they affect sperm or eggs. If you were to edit somebody in a way that led to a change in their kids, meaning you cured their condition for all time, that's very bad in the US Reasons. I don't think they're good reasons. I think”

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

  3. “Enormous numbers of gene therapies for things that have just never been touched before. And we know this because if you look at novel gene therapies, they're coming out ahead. And this is about like, I think it's like the same year they come out ahead. Yeah. First ever phase one appearances. They are rushing ahead of the US. The US has had like, like in 2025, we had like 20 something new gene therapies that have never been done before entering phase one. And China had six times as many. And so you can tell”

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

  4. “Are these Chinese drugs just me too? So the answer is no. These are cell in gene therapy trials. Most cell and gene therapy targets have not been done yet. There are very few actually approved gene therapies. I mean, very few is relative to whatever your personal metric is, but I say there's not very many of these drugs yet. And China is doing tons of these trials. They are going after”

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

  5. “So these are immunotherapy checkpoint drugs. They uh, they make it so you can like your immune system can respond better in the course of cancer treatment. We added on the chemotherapy. People are recovering at rates we've never seen before. Like, it's a really, really good thing. These drugs have been revolutionary, and that's why they make so, so much money. They were the top grossing drugs until I think last year or the year before, where GLP1s have overtaken them.”

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

  6. “Came down immediately because the number when you have like 10 drugs in a space, the cost of the drug is like 90% down. When you have two drugs, you're like having the price. This is a pretty expected thing. Another company jumps in. They lower the price. China didn't just do that. A lot of drugs have done this though. Like we have all these MABs that are used in immunotherapies. These are all cancer immunotherapy drugs. And they are clearly Me Too drugs. They just copy the leader because the leader here has made so, so much money. Pembro has made an incredible, incredible amount of money. But China is not just a content.”

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

  7. “It's incredible. They also aren't just Me Too drugs. So, one of the things China's been accused of for a long time is just doing Me Too drugs. And a Me Too drug is where you basically see a new drug get approved and then you copy it immediately. And this happened with the cure for hepatitis C. It was either Amgen or Gillia I did it first, but then Amgen or Gilead, whichever one wasn't the first one, copied them the next year with a drug that was incredibly similar to their little retroviral combination thing. And then the actual price on the drug that is paid by the insurers, the net price, not the price that's listed that you can see.”

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

  8. “And this does translate into real things. So these are new drug approvals, and these are drugs first approved in China. China is actually getting drugs approved. These are drugs that are going to actually show up in drugs people do end up using. These are not just trials that they initiate that do nothing They predict”

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

  9. “If you look at this and just put it together like this with everything lumped together, you can see, yeah, they've clearly surpassed the US. They surpassed us during COVID and they were on that trajectory field a while. During the first year of COVID, they had like a little slowdown. Everything kind of got muffed up there. But now it's doing fine exceptionally. running amok they're going incredibly fast and this is already more than the eu does as well the eu does a little less than the us in total so if you combine the us and the eu the free world is still like ahead of china but uh that's not going to last for long because both the eu and the us are on these like kind of relatively flat trajectories whereas china is on the up and up”

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

  10. “This is what solar panels look like. This is probably what silicon is going to look like soon. It's everything. And if it's not there yet, it's going to be. It's a really alarming thing, but it keeps happening.”

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

  11. “Better. They're definitely rising more. They're not really, I mean, they haven't been doing this for as long. You can see how they had like a big, big, big jump since 2016 is when they did their big clinical trial reforms. And if you put these side by side, you'll see that China is actually now ahead of the US in terms of running clinical trials. They are, and in the short span of a few years, in 20 years, they've managed to go from doing practically no clinical trials to doing more than America.”

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

  12. “Yeah, it's more than 90% failures. It's really bad. Your top reason is, oh, it's just not safe. Or it goes from preclinical to human and does nothing. No efficacy, and then it just dies, and then the pipeline is emptied. And some things can be rescued from the pipeline. That's a different topic about repurposing. Like, you know, Vivek Ramaswamy's business, he gets really Roy Vant. Basically, he finds drugs that have been abandoned and he looks at them and he goes, Oh, this actually helped this secondary endpoint. Let's go pick up that drug, buy it for cheap because it was abandoned, and then repurpose it for this other thing. And then like it actually seems to be kind of this kind of”

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

  13. “All right. So America runs a lot of phase one, two, and three trials. It runs more than 1,500 a year in recent years. It used to run fewer than that. It's been increasing somewhat. You can see that it went from like 1,300-ish to 1600-ish in the most recent year. The reason that last year is the 2025 data is marked as a little different color. It's because it's possibly incomplete. There might be some more filling in of the data sources as time goes on. But basically, you can just see where America stands in terms of running clinical trials. Most of our clinical trial pipeline is in phase twos. That's often where things fail. In phase one, they often fail to. I mean, every step, there are a lot of failures. And what's the total rate?”

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

  14. “All right, so basic general thing if you don't know what a clinical trial is, they're usually the four phases that's agreed upon by different countries. They have this thing called the ICH, Council on Harmonization, where tons of different member countries came together and they agreed on some general ways trials are laid out. And those general ways are like, you know, do a phase one, show that it's safe, then do a phase two where you target some group of people that's like a little larger, and then you show that it's safe and it works. And then you go to phase three where you get like a big population representative sample or whatever, the drug population user representative sample is. And then once it works on that, we approve the drug. And then phase four is not really an actual genuine trial phase. It's just post approval monitoring to make sure the drug remains safe and efficacious and whatever else. So those are the general steps in a clinical trial. And I've simplified there, but that's basically how it works.”

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

  15. “So it sounds like without kind of presupposing, you know, without getting ahead of you here, it sounds like the kind of general story here is there are good aspects to if we're looking. Kind of cutting edge medical research, and there are, you know, and I suppose again, I don't want to get ahead of your conclusion here, but it strikes me that there are probably process reasons, kind of internal bureaucratic and policy reasons in the US why China has been able to pull ahead here in what you might think is an area where the US has a natural advantage. So maybe I'll stop just predicting what you might be able to say and let you go through and take us through your thoughts here, Grandpa to hear.”

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

  16. “I was thinking Jack Maun, I was like, wait, that sounds right. Okay, so yeah, they basically took him right out. They can do whatever they want. If it is in their interest, they can just decide that it's over and you're not selling that drug to America for ideological reasons.”

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

  17. “It definitely isn't some ways. I'll actually get to some of those when I start the presentation. But the thing is, at the end of the day, all the corporations do serve the government. They have a whole government bureau, the military civil fusion bureau. And if they so wish, they can stop exports of things. They can stop production of things. They could totally reorient their supply chains and take control of companies, fire, kill, jail, bosses of companies. Who was that CEO a few years ago, very famous billionaire who they basically just totally deposed him from his company?”

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

  18. “And that's great. It means we get more medicines and treatments and things that'll keep us alive too. So it's really good in that respect. The more innovations, the merrier. The big downside is that China could just at some point say, hey, we've got the cure for cancer and we're not going to share with you. Would Would be really bad”

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

  19. “India is licensing. Okay, so they've become large. They're number two. They're still enormous. That region, the Asia region, that broader East Asia region, including Southeast Asia, is something like half the world population. It's enormous. It's so, so many people. And they've not been innovating, not been pulling their weight. But now they are. Now they are pulling more than their weight. I mean, the US is kind of pulling more than its weight too. I think they're pulling a pretty big share. They're out innovating per capita Europe now, which is really, really incredible.”

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

  20. “So there's good and bad to this. It's really good that China is actually now innovating because for a long time, they've been, they're the largest country. India might be, I think, larger by population now. I'm not sure I have to check that.”

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

  21. “To even take a further step back, sorry, but just to take a further step back, Crimea, it's like, so why do we care about that at all? It's like we can see the number right in saying the number of, and it's not just medications, right? You could say more generally, it's like interventions. So the number of interventions that are kind of making it through clinical trial and being approved for use, China is leading in that number now. And why does that in a very kind of surface level, someone might say, who cares who comes up with it? Surely the US is going to be the largest market for it. Surely there's going to be all these process improvements. I mean, GLP1s, obviously kind of originally developed overseas. It's driving the trade deficit with that country, but the biggest markets in the US. So tell us a little bit more about that.”

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

  22. “Yeah, so in recent years, ever since 2016, China has been just up and away the big, big leader in biopharmaceuticals. Biotech and producing new drugs, even producing new medical devices, they're getting way ahead of the US. For decades, the US has been the top dog by a huge margin. We've produced something like 40% of all of the world's medical innovations when you talk about things that are approved and things that actually work. And that is no longer the case. China is actually ahead of the U.S. now. And I'm going to show you some documentation of that. Some people haven't realized it yet. It hasn't really leaked to the press at this point. They don't realize that China is actually the top dog now. Which upsets things. It changes a lot. And may”

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

  23. “What happens when the United States is no longer the leader in biomedical innovation? For decades, the U.S.-dominated drug development, producing a large share of the world's new therapies and setting the pace for clinical research. But over the last few years, that started to change. China has rapidly expanded its clinical trial system, accelerated approvals, and is now leading in both volume and novel drug development. This shift isn't about scale, it's about systems, regulatory design, trial structure, funding models, and incentives all shape how quickly new treatments reach patients and where innovation happens. The question now is whether the U.S. can adapt or whether the center of gravity for biotech continues to move. Theo Jaffe and Gabriel Dickinson speak with Cremieux.”

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

  24. “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 one and type 2 error rates are both down for China because they run bigger, better trials. China says, well, no, we're going to make you profitable. 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 should be better off in general.”

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

  25. “America is 4% of the world's population. It's 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 innovation does respond to the money and it has to.”

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